You`ve Graduated, Now What? - Academy of General Dentistry

Transcription

You’ve Graduated,
Now What?
A Guide to Navigating Those First Years
in the Dental Profession
By
Richard W. Asa
and
John W. Portwood, Jr., DDS, MS, CFP, ChFC, MAGD
Sponsored by Dentist’s Advantage,
a division of Affinity Insurance Services, Inc.
Table of Contents
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You’ve Graduated,
Now What?
A Guide to Navigating Those First Years
in the Dental Profession
By
Richard W. Asa
and
for the Academy of General Dentistry
Sponsored by Dentist’s Advantage,
a division of Affinity Insurance Services, Inc.
© Academy of General Dentistry, 2007
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With special thanks to
Richard W. Asa
AGD Council on Communications, 2006-2007
Michael L. Bydalek, DMD, FAGD, Chair
Cheryl B. Billingsley, DDS, FAGD
William E. Chesser, DMD, MAGD
John V. Gammichia, DMD
Norman D. Magnuson, DDS, FAGD
Robert Margolin, DDS, FAGD
Timothy B. Menke, DDS
Melvin K. Pierson, DDS, FAGD
Bruce M. Scarborough, DMD, FAGD
Ralph A. Cooley, DDS, FAGD, Board Liaison
Peter G. Sturm, DDS, MAGD, FADI, CDC, Consultant, AGD Associate Editor
Roger D. Winland, DDS, MS, MAGD, Consultant, AGD Editor
Lawrence Bailey, DDS, MPH, FAGD
Norman Barnum, CPA, The Barnum Group
Mark Buczko, CPCU, CIC, RPLU, Vice President, Dentist’s Advantage
John P. Little, DMD, JD
Michael D.L. Weisenfeld, DDS, FAGD
Designed by Tim Henney, AGD Manager, Production/Design
Illustrations by Jason Thomas, AGD Associate Designer
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Table of Contents
Introduction.................................................................... 1
Chapter 1
Goal Setting.............................................. 3
Chapter 2
Practice Options...................................... 15
Chapter 3
Business Organizations............................ 27
Chapter 4
Systems Development ............................. 39
Chapter 5
Marketing............................................... 65
Chapter 6
Financial Planning ................................... 75
Chapter 7
Networking........................................... 119
Chapter 8
Continuing Education ........................... 127
Chapter 9
Organized Dentistry .............................. 135
Chapter 10
The Beginning....................................... 145
Your Checklist to Success............................................ 149
Resources ................................................................... 159
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Introduction
This manual was developed by the Academy of General
Dentistry (AGD) in response to the many requests by practicing
dentists for more essential business information to help new
dentists successfully start their practices. The need for more of
this type of information stems from the limitations of the dental
school environment, which is primarily clinical out of necessity.
Yet, comprehensive business skills are required in the actual
practice of dentistry.
Without practice management skills, success is far more difficult
to achieve. But where can new practitioners go to find these
skills?
The AGD decided to provide a primer on such nonclinical skills,
so new dentists could hit the ground running and get a head
start toward success. This manual cuts through the usual fluff
and delivers essential information. The topics include account
ing, business management, and financial planning, all of which
can be mastered with time and application. With this manual,
newly practicing dentists will have a practical template that
they can use to shape their practices and careers.
While we provide detail on the nuts and bolts of these subjects,
we also offer observations from practicing dentists. New
dentists can rely on their long experience. I think you’ll find
that their views and commentaries not only underscore and
support the topics at hand, but are thought-provoking as well.
Be assured that these dentists have faced many of the practice
challenges you may now be facing, and they want to share with
you what they’ve learned in the process. After all, there is no
greater teacher than experience.
This manual also includes forms and a Checklist to
Success to help you put your thoughts into action.
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The AGD, the second largest dental organization in the United
States, was founded on the belief that continuing dental educa
tion is the cornerstone of quality care for patients. The AGD
remains focused on lifelong learning, yet it has expanded its
vision to include legislative advocacy that protects the rights of
general dentists. This manual for new dentists was developed
with the AGD’s continuing mission in mind.
Special thanks go to the individuals and groups who partici
pated in this project. It is rare, but gratifying, when such an
excellent team comes together to accomplish a goal.
I also would like to thank Dentist’s Advantage, which funded
the manual’s publication and is making its distribution possible
to all graduating dental school seniors.
It is my sincerest wish that this book imparts a level of
knowledge that makes your career easier and more enjoyable.
Dentistry is, without a doubt, the greatest profession in the
United States today. In what other line of work can you have
a career that is so financially rewarding—as relative to the
reasonable schedule most dentists keep—while also providing
the respect, trust, and even adoration of your customers—your
patients? Improving and maintaining your patients’ health care
and well-being lies at the heart of what dentistry is all about.
Relish your new profession—and may you have a rewarding
and successful career.
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Chapter 1
Goal Setting
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Chapter 1
Goal Setting
Achieving Clarity
Now that you’re out of school and raring to go, what’s first? Your fu
ture is swirling through your head like a tornado, picking up an idea
here, an idea there. Bits of a plan emerge from the seeming chaos.
This is the time for goal setting, that tedious but completely neces
sary first step in the process toward success as you define it. Some
day, looking back, you’ll see your goals were met not with a wing and
a prayer or luck, but with sound planning and a clear-eyed, step-by
step approach that methodically takes all contingencies into consider
ation. Your first goal is reaching clarity on your career.
Success, in whatever form it takes for you, occurs through a designed
plan, not by serendipity or chance. Factors that can cloud your think
ing and generate that internal confusion include:
• fear of failure.
• poor self-image.
• uncertainly about the necessity of goals.
• a lack of time.
• a lack of skills necessary to set goals.
The good news is that these factors all can be overcome by the goal
setting and planning process. But before we get into the “how” of set
ting goals, we want to talk briefly about these various roadblocks.
Fear of failure and poor self-image are many times reinforced by life
experiences or, more importantly, by our family members. Subcon
sciously, family members may feel that since they did not achieve a
certain level of success, then nobody in the family can or should. It is
this pressure that often keeps us grounded instead of reaching for the
stars. The way to overcome the negative is by viewing ourselves as
being successful in both life and work. Sometimes it is more impor
tant to recognize that, while we may have failed to reach our ultimate
goal, we did accomplish much along the way. Also, remember that
ultimate failure is not failing to succeed, but failing to even try.
It also is important to remove negativity from your vocabulary, and
“I can’t” should be the first phrase to go! If you can perceive it, you
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Goal Setting
Chapter 1
can achieve it. Trust yourself to know which goals you should and are
able to go after, remembering that even if you don’t achieve the pri
mary goal, the steps that you accomplish along the way will no doubt
make you a better individual than you would have been otherwise.
Many times we hear individuals saying that they do not have the
time to set goals. In fact, not only do you have the time, you will
save yourself even more time in the long run by taking a few extra
minutes now to set your goals. It is important to understand that goal
setting clarifies the vision in your mind. With a clear vision of the
ultimate goal, the steps to success become more concise and ensure
time efficiency. Don’t confuse activity on an issue to be the same as
the ability to ensure its success; for example, a couple spends more
time planning their wedding than planning the actual marriage,
which is far more critical!
“Setting goals is defining the
vision of who you are, where
you’re going, and what will
guide your journey. The goal I
set to get my AGD Mastership
has truly enriched my life.”
Remember that luck favors the prepared! Without goals, there is no
path to follow. You are trying to reach your ultimate achievements,
and setting your goals will get you there!
AGD President, 2005-2006
The Goal-Setting Process
To start, get a pen and refer to the goal-setting form that we have pro
vided at the end of this chapter. Yes, you do have it all in your brain’s
folds, but writing it down is a time-honored way of reinforcing solid
goals and eliminating gratuitous thinking. That’s why so many people
keep journals, or are told to keep a journal, when a situation, and a
solution, is unclear. Career planners will tell you that psychological
blocks can cloud your thinking. If you believe you are one of those
people who is so clear-headed that you have no internal battle going
on, think again. If you are human, it’s going on whether you are con
scious of it or not. Your answers are there, perhaps hidden, but can
be freed only when you look carefully at your impending career and
what you want from it. You can eliminate the extraneous, the unat
tainable, and the unrealistic from your plan by seeing it presented in
a concise format. Still, make sure that your ultimate goal challenges
you to push your boundaries.
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Bruce Burton, DMD, MAGD, ABGD
Hood River, Ore.
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Oregon Health & Science University, 1980
Chapter 1
Goal Setting
Step No. 1
Put your goals in writing.
It is important to be clear and concise in your goals. For example,
stating that you want to be in a new house in a few years is not a
goal—it’s a desire. The goal side to that desire would be to state that
you want $100,000 saved in the bank to act as a down payment on
the new house that you will start construction on five years from
today. That is a goal. It is clear, concise, attainable, and within a set
timetable. With the goal now written down, it will remain firmly
written in your mind.
Step No. 2
List reasons and benefits for each goal.
This is an exercise in
positive thinking, so
consider the life factors
that make you a
well-rounded individual.
Now, write down on a separate piece of paper why the goal you listed
is important to you. Your reason needs to be just a sentence or two.
If you can’t think of a very good reason for accomplishing it, then it
probably wasn’t a very good goal to begin with.
Be sure to achieve balance in your goals. If you become dominated by
a particular type of goal, say financial, you may become subjugated
by that goal at the expense of family relationships and spiritual goals.
Again, you want to avoid those considerations that can warp your
thinking and make goal setting counter-productive. This is an exercise
in positive thinking, so consider the life factors that make you a wellrounded individual:
• Personal
• Career
• Family
• Financial
• Spiritual
• Physical
• Mental
First, define what these categories mean to you. A personal goal, for
example, could mean anything that sees you grow and progress as an
individual. Family goals are those that affect interpersonal relation
ships with your family. Spiritual goals are usually short-term goals that
affect our spirituality and peace of mind. Career goals are those that
further us in our dental profession. Financial goals are just what they
imply; they are goals that improve our bottom line and provide us with
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financial security. Physical goals are also short-term goals that imply
a sense of physical well-being. Mental goals are many times related to
continuing our education and improving our mental state.
Second, try to set goals in several, if not all, of these categories. Ini
tially, career and financial goals may dominate out of necessity, but
don’t allow these to overshadow areas, such as relationships, that are
just as important.
As you list the life factors pertinent to you, do some soul-searching
at the same time. This can be slow and difficult at first, particularly
if you are the type who tends to keep introspection at bay in favor of
action. The potential problem with your action approach is that soon
er or later—and probably sooner—you will have to face the music.
Do yourself a big favor and make it sooner. Later on, as your career
becomes more complex and your responsibilities more demanding,
you may regret acting before thinking. Use this time of transition
from education to practice to ask yourself the hard questions:
Is this goal mine or someone else’s? This is a big one. Given your envi
ronment, the people you know and love, peer pressure, and self-ex
pectations (achievable or not), you can easily start making decisions
based on goals outside of yourself. Ultimately, success will hinge on
goals stemming from your own vision.
Is this goal moral and ethical and is it fair to everyone concerned? Yes, take
the high road because, in the long run, your career will benefit and
your goal will be met. You have trained to be a physician of the mouth
and, as such, you have a responsibility to your patients and to yourself.
Lessen the internal battle we all wage within and do the right thing
from the beginning. As a result, you will sleep well at night.
Will this goal take me closer to or further from my main objective? This
consideration requires honesty. Sure, that Lamborghini would be
sweet to own and impressive on the street, but does it help you to
meet your ultimate goal and the success it defines? While change
is inevitable in every walk of life, stay on the beam. It’s one thing
to make a change because you’ve run into an obstacle along your
chosen path; it’s another to set up hurdles every step of the way by
losing sight of your vision.
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Goal Setting
Can I start and finish this goal? This calls for some finesse. Do not limit
yourself before you even get started, so set your goals high, albeit re
alistically. You will then need to ask yourself what is actually realistic
for you given your current circumstances. A goal worth achieving is
a goal that can be achieved when you consider all of the factors that
go into a career. The other side of the coin is constant frustration and
loss of self-esteem. Strike a balance between optimistic and realistic.
“Goals create the mental Can I visualize myself reaching this goal? The simple answer is either
yes or no. If you can clearly see yourself getting there, in the context
of your goal setting and career planning, then you can. If you can’t,
if you keep running up against obstacles in your mind, you need to
revisit your plans to find a clearer path that is in sync with who you
are. Be honest with yourself.
picture of what you are striving to achieve. Once you articulate your goals, remember that this is a dynamic process. You need to periodically re-evaluate your goals, revise any goals that need updating, and recommit to the pursuit of your goals.”
Thomas A. Howley, Jr., DDS, MAGD
Perkiomenville, Pa.
Step No. 3
Identify obstacles.
Obstacles are those speed bumps that slow us down on our jour
ney. The more we can identify them before they happen, the more
prepared we are to deal with them. What we don’t want is to be
blind-sided by something we are totally unprepared for. Planning for
contingencies is something you must get used to in your professional
career.
Step No. 4
Temple University School of
Dentistry, 1981
Identify resources needed.
At this point, you have a clear idea of your goal, the reasons you want
to accomplish that goal, and the obstacles that might be in the way.
Now, identify the resources you believe will be needed to help get
you there. Resources, of course, can be financial and that’s probably
the first resource you consider, yet there also are valuable human
resources, too. These include an attorney, professional consultant,
and an accountant. They can include professional organizations, such
as the Academy of General Dentistry or American Dental Associa
tion, as well as the local dental society. And then there are inner
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Chapter 1
resources—the inner ability that is drawn on in a time of need. In
other words, think of resources in the most global sense of the word
(i.e., somebody or something that can be used as a source of help or
information).
Step No. 5
Set up intermediate goals.
The purpose of this is to try to make achievable marks along the way
that allow you to feel a sense of success. These intermediate goals
also help to keep you on a clear and timely path to your ultimate
goal. Be sure these intermediate goals support and do not distract you
from moving toward your ultimate goal.
Success, in whatever
form it takes, occurs
through a designed plan,
not by serendipity or
Step No. 6
chance.
Make any personal changes necessary.
If you must make personal changes to achieve these goals, be sure
that you are willing to do so. Sometimes we may have to make
changes in our personality or work ethic that sound good, but may be
too difficult to accomplish. Evaluate yourself closely on this one and,
most of all, be honest with yourself.
Step No. 7
Write a completion date.
Finally, mark a goal-setting completion date. This step supersedes any
procrastination that might seep in while time constantly moves on.
Don’t dig a hole for yourself that you have to climb out of. Set a dead
line for completion of your goal setting and stick to it!
You now have all the tools to be successful in setting your goals. The
only thing missing is determination and self-fortitude.
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Chapter 1
Goal Setting
The Enemy—Procrastination
Procrastination feeds on itself until it becomes a monster. Push
through procrastination and the human foibles that drive it. Here’s
how:
“Goal setting is the systematic
and methodical means of
defining your own personal
and individual focus, purpose,
and direction. Effective goals
are clear-cut and direct, and
they reflect the things you
value both personally and
Set deadlines. You have become accustomed to working with dead
lines throughout your educational experience. Just because school’s
out, don’t let go of that method of discipline. Set a reasonable time to
achieve your ultimate goal, as well as intermediate goals to be accom
plished at specific times along that timeline.
Avoid absolutes. Do not back yourself into a corner. Remember that
success can be measured in terms of the ability to change. Be flexible
when the time calls for it.
professionally. Yogi Berra
summed it all up when he
said, ‘If you don’t know where
you’re going, you’ll end up
someplace else.’”
Eugene Antenucci, DDS, FAGD
Huntington, N.Y.
New York University College
of Dentistry, 1983
Break the task into components. In other words, how do you eat
an elephant? One bite at a time. Don’t overwhelm yourself before
you get started by trying to do everything at once. One bite at a time
will get it done soon enough. Remember to set intermediate steps,
each with its own timetable. This will keep you on track.
Reward yourself. This is very hard for many people. It seems much
easier to punish yourself for failing to be superhuman than it is to
reward yourself for the completion of a necessary task. That doesn’t
mean you should drop everything for a trip to the Bahamas. It might
be as simple as rewarding yourself with an ice cream cone after a
long day.
Use the 10-minute rule. Each one of us has certain jobs that we
hate doing…you may even be avoiding that job by reading this
manual. There is a way, however, to get motivated. Set a clock for
10 minutes and tell yourself that you will work for only those 10
minutes. You will find that, once you get into a project, you will have
the motivation to follow through with it. This technique is primarily
a method to get your motor going.
Just do it! When all else fails, just do it.
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Goal Setting
Chapter 1
Each of these techniques will make it simpler to avoid procrastination
and achieve your goal. Ultimately, it must be you who is focused and
determined to achieve the goal. Do you have it in you? Of course you
do! You wouldn’t be reading this manual if you didn’t.
The Business Plan
Yes, the practice of dentistry is a business. You’ve no doubt heard
that, yet many recent graduates ready to step into practice have
missed that point over the years. There are many mitigating factors,
all understandable, involved in the desire to get down to the nitty
gritty of making money. Yet, more than ever, dentistry is a business
that must be managed well for your ultimate goals to be achievable.
You get there by running a tight ship and that only comes from devel
oping a business plan.
The development of a business plan is a natural segue from goal set
ting. In fact, nearly everything required of you in your professional, as
well as your business life, will require goal setting as a starting point.
Your business plan will require a clear vision. That clarity can
involve asking yourself questions about objectives. Here are several
visions:
• To cultivate satisfied, appreciative, and prevention-oriented
patients.
• To develop a sense of high ethical standards.
• To create an environment that minimizes stress to your patients
and staff.
• To cultivate a feeling of professional and personal achievement
and well-being.
• To provide a balance between professional and personal needs.
• To optimize practice productivity and income.
• To gain a reputation for compassionate, quality care.
Your business plan should include the achievement of goals. Those
goals you set for your career during that goal-setting exercise will
come in handy now. You will need to establish in your business plan
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With a clear vision of the
ultimate goal, the steps
to success become more
concise and ensure time
efficiency.
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Chapter 1
“It took me 12 years of
practice before I realized the
value of goal setting. If I had
started out setting goals, from
my first months as an associate
Goal Setting
your goals and how you plan to achieve them from a business per
spective. These include topics such as production and collections, risk
management (insurance), marketing to the public, management of
your staff, retirement planning, and so forth. This allows you to iden
tify areas of weakness in your knowledge and provides a springboard
to eliminate uncertainty. Feeling a little overwhelmed? Don’t worry:
We will work through many of these essential topics as we proceed
through this manual.
dentist and then as a selfemployed dentist, I would have
been years ahead in all facets
of my life, and I would have
saved a lot of money.“
Cindi Sherwood, DDS
Independence, Kan.
University of Missouri,
Kansas City, 1982
Your business plan should include assists in financing. If you don’t
have a clear picture of where you are going professionally, how can
you expect a lending institution to hand you money to get there?
When you develop a business plan, it allows financial institutions to
gauge your creditworthiness. In showing them that you understand
your financial needs and the business that you are going into, you
allow them to be more favorable in granting your loan request.
You will need to have a business plan that outlines your projected
income and expenses for the initial years of practice, as well as
personal financial statements calculating your net worth in terms of
capital available to cover start-up costs. We will discuss this further in
a later chapter of this manual.
As we move into subsequent chapters, we will constantly refer to the
essential element of goal setting. With a firm grasp of where we are
going and how we are going to get there, we are well on our way to
practice success!
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Goal Setting
Chapter 1
Goals
Turning Dreams into Achievements
Goal: _____________________________________________________________________________
Whose goal is this? ________________________________________________________________
Benefits received from accomplishing this goal: ______________________________________
On a scale of 1 to 10, with a 10 being extremely important, what number is this goal? ____
Will this goal:
Make me happier? ................q Yes ......... q No........ q No Effect
Make me more spiritual? .......q Yes ......... q No........ q No Effect
Improve my career?................q Yes ......... q No........ q No Effect
Make me more money? .........q Yes ......... q No........ q No Effect
Improve me physically? ..........q Yes ......... q No........ q No Effect
Improve my family life? ..........q Yes ......... q No........ q No Effect
Improve me intellectually?......q Yes ......... q No........ q No Effect
Resources needed to accomplish this goal:
Educational needs: __________________________________________________________________
People needed: _____________________________________________________________________
___________________________________________________________________________________
Obstacles faced:
1.) ________________________________________________________________________________
2.) ________________________________________________________________________________
3.) ________________________________________________________________________________
4.) ________________________________________________________________________________
Intermediate goals I must accomplish first: ___________________________________________
___________________________________________________________________________________
What changes must I make in me to see this goal to its completion: ___________________
___________________________________________________________________________________
Completion Date: _____________
Make copies of this page and complete one page for each goal.
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Chapter 1
Goal Setting
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Chapter 2
Practice Options
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Chapter 2
Practice Options
Getting Priorities Straight
If you share a similar
philosophy and outlook
with the seller, the
chances are good that
the staff and your
new patients will have
a relative seamless
If you feel overwhelmed by the decisions you need to make, remem
ber that you have plenty of company. Few dentists have ever left
school with their futures carved in granite. Those who did were able
to do so because they had tangible goals and plans. Perhaps the most
important, if not the most difficult, decision involves how to practice.
With one of the golden rules from the first chapter in mind, remem
ber to make your decision on practice options based on what’s best
for you rather than for that invisible judge that seems to sit on your
shoulder, telling you what to do.
Years ago, of course, the decision was less complicated, because so
many young dentists found a suitable location, hung out a shingle,
and had a go at it. Most did quite well during the high caries era that
some refer to as “drill, fill, and bill.” You look around at the dental
landscape today and it’s evident that times have changed. There are
more options, which makes your individual decision all the more
important. Some factors in your decision will include your personal
and professional needs and the economy and business climate in the
locale of your choice.
transition.
Making an Informed Decision
Obtaining professional assistance for your transition to dental prac
tice will prove invaluable in helping you make the right decision.
You should retain an accountant, lawyer, and insurance broker. You
also should consider consulting with a practice evaluation/transition
specialist who can oversee the transition and coordinate the other
advisors. The costs of proper advice will more than offset the finan
cial mistakes good advice enables you to avoid. A word of caution: Be
wary of advisors who attempt to represent both sides in the negotia
tions. They may not have your best interests in mind.
There are three basic practice options available to the recent gradu
ate: associateship, purchasing an existing practice, or opening a new
practice of your own.
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Practice Options
Chapter 2
The distribution of private practice falls in the following way:
• 75.3 percent (sole proprietors)
• 14.3 percent (partners)
• 6.8 percent (employees)
• 3.6 percent (independent contractors)
A little more than half of all young dentists (52 percent) are sole
proprietors. Another 17.6 percent are partners and 30.4 percent are
non-owners. Two out of every three dental graduates begin their
careers as associates. This form of practice holds obvious enticement
for a young and asset-poor graduate who may owe a small fortune in
educational loans.
“The question you need to
ask yourself is this: ‘What
particular practice model
works best for me at this point
Associateships
in my life?’ You must make
The early career advantage of an associateship lies in several factors:
• You can earn a steady income immediately, which can be particu
larly important if you are in debt.
• There is limited financial risk as you gain your footing in the pro
fession.
• You have the opportunity to learn clinical skills and gain procedur
al speed under the watchful eye of a veteran dentist. Sound advice
of all kinds, clinical or otherwise, is readily available.
• There is the possibility of long-term employment as a full partner
in the practice.
you want from life and your
In 2001, the average net income for a full-time associate was
$109,800. One-third of associates were paid on a percentage of
production, which averaged 33.9 percent. One-quarter were paid on
a percentage of collections, an average of 36.4 percent. Another 25
percent were paid an annual salary; the average being $92,900. Ten
percent received an hourly wage at an average of $56 per hour.
Temple University School of
Dentistry, 1981
the decision based on what
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practice, not what you think
you should do or what would
impress others.”
Thomas A. Howley, Jr.,
DDS, MAGD
Perkiomenville, Pa.
Chapter 2
“Once you have graduated
from dental school, the rollercoaster ride begins. There are
many different ways to begin
practicing and, in all of them,
there are challenges. We are
in a great profession, you just
have to find your groove.”
John Gammichia, DMD
Orlando, Fla.
University of Florida College of
Dentistry, 1995
Practice Options
Those who make a successful go at an associateship tend to bring the
following factors to the table:
• They complement the personality of the owner (naturally or con
sciously).
• They share similar core values and practice philosophy.
• Their long-term goals match the owner’s long-term goals.
• A written contract has been perused, understood, and signed by
both parties. (This is no small accomplishment. Many young den
tists are dazed and confused by the voluminous fine print in many
contracts.) If you don’t understand exactly what you’re signing,
don’t sign it until you do. You should pursue legal advice.
Keep in mind that any contract worth the paper it’s printed on lays
out employment terms in clear and concise language. Confusing
clauses and unnecessary gobbledegook are signs that you are not on a
level playing field with the hiring dentist. Don’t hesitate to walk away
if those alarm bells start ringing in your head. In time, you will find
a job. This is the time for you to firmly adhere to your personal goals
and practice philosophy.
Any contract you sign must have the following clearly expressed
basic elements:
• Expected duties and responsibilities
• The compensation package
• Benefits (such as vacation, insurance, continuing education allow
ance, etc.)
• The possibility of a long-term, buy-in agreement with a specific
date as to when negotiations for the buy-in can begin and end
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Chapter 2
Types of Associateships
There are three types of associateships: employee, independent con
tractor, and time share. Each has its advantages and disadvantages,
which depend on your personal and professional preferences and
short-term versus long-term goals. Depending on the type of associ
ateship, the main difference is the level of control you have over your
own fate.
Employee. The practice owner is the employer, and you are the em
ployee. Often, associates will be hired to expand the owner’s patient
base and expand the types of procedures performed. You usually
do not have to worry yourself over the purchase, maintenance, and
upgrading of expensive dental equipment or the hiring of support staff.
You will likely have the least amount of autonomy in this arrangement.
Advantages
• Little or no financial risk
• Steady, predictable income
• Possible benefit package
• Set hours
• Fewer responsibilities
Disadvantages
• Limited, if any, autonomy
• No ownership of patient records
• Limited potential for growth
• No practice equity
Independent Contractor. As an independent contractor, you are a
self-employed dentist. If that’s one of your main priorities, this arrange
ment may work best for you. On the other hand, you are essentially on
your own, responsible for such practice elements as insurance, bene
fits, hiring, and equipment purchase. The owner dentist may be willing
to negotiate terms for the sharing of his or her staff and equipment, but
this must be spelled out in the contract. You might be able to keep your
records with a contractual agreement, but the owner will want some
sort of written assurance that he or she at least has access to those. The
key to entering into an agreement as an independent contractor is the
level of autonomy and control you retain. If there is what you deem to
be too much control by the owner, you are essentially an employee in
a contractor’s suit. Make sure to carefully work out, in writing, exactly
how much freedom you will have.
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“The most important thing,
as an employee dentist, is
working well with the owner
dentist and other employees.
Understand and respect
the contract between the
owner and employee and get
everything in writing, including
hours, patient assignment,
and responsibilities within the
practice.”
Carolyn Taggart-Burns, DDS
Omaha, Neb.
University of Nebraska College
of Dentistry, 2002
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Practice Options
There are specific IRS regulations delineating whether a person is an
employee or an independent contractor. Additionally, in some states
(such as New Jersey), if a dentist is paid on a percentage basis (i.e., 35
percent of collections), then the dentist must be paid as an employee.
The potential liability and the insurance needed for employees and
independent contractors differ greatly. It is strongly recommended
that you check with your lawyer and accountant if you want to be
considered an independent contractor.
Every decision you make
Advantages • Greater automomy • Easier start-up • Decreased costs • Owner dentist may refer patients
related to the patients’
level of comfort and
cooperation adds value
to your practice, from
how people are greeted
at the door to how long
they sit in the chair for
treatment.
Disadvantages
• Owner dentist controls the
procedures performed
• Usually no ownership of records
• Responsible for supplies
• Responsible for staff and
equipment
Time Share. This subset of an independent contracting arrangement
is not as common, but it works for some young dentists with particu
lar goals and resources. You rent time, space, and equipment within
the established practice. Each dentist in the time-sharing arrange
ment maintains a separate practice, with his or her relationship lying
mostly in the physical space they share. For this reason, it’s essential
that the agreement is clearly spelled out in writing since you are
sharing space but not necessarily much else. If you need to purchase
equipment, maintenance, and supplies, for example, that should be
clearly expressed in the agreement.
Advantages • Full autonomy • Less financial risk compared to full start-up
• Ownership of patient records
• Ability to develop practice equity
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Disadvantages
• No guaranteed income
• Full responsibility for building patient base
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Practice Options
Purchasing a Practice
The potential advantages inherent in this option are fairly obvious. If
an agreement is reached with your future in mind, you will inherit a
practice that includes ready-to-use equipment, a patient base, and a
location that suits your goals. The obvious potential disadvantage is
that you could end up buying a practice with antiquated equipment
and systems, an indifferent staff, and a patient base that has seen
far better days. A thorough investigation into the condition of the
practice as a whole is crucial in avoiding that potential trap. Like
any other practice option, there are advantages and disadvantages to
consider.
Advantages • Easier transition • Immediate cash flow
• An established patient base
• Existing office • Established name and contact information
• Inherited staff
• Business ownership advantages
Disadvantages
• Initial cost
• Reputation tied to previous
owner
• Immediate transition to full-time
• Staff acceptance
• Patient acceptance
Some of the potential disadvantages, such as staff and patient accep
tance, can be eliminated by a careful consideration of your practice
philosophy and that of the seller. If you share a similar philosophy
and outlook with the seller, the chances are good that the staff
and your new patients will have a relative seamless transition. It’s
important to look for signs that a practice you want to buy is the right
practice for you to buy.
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Practice Options
Speaking of which, evaluating the values of a practice will give you a
ballpark idea going in that you are making a sound investment. Value
factors include:
• Determining gross income.
• Evaluating net income.
• Scrutinizing office expenses.
• Determining debt service.
• Determining the sellers’ adjusted income.
• Evaluating spendable income.
Sounds simple, but doing your homework before you take the leap
will benefit you in the long run.
Starting Your Own Practice
Beginning your professional career with your own practice puts you
in good company. Most dentists in the modern era have preferred,
and still prefer, to be their own boss. The clearest advantage is your
complete autonomy. If you have a solid vision for your practice and a
plan that articulates what you will need and how to find it, going out
on your own right out of school may be practical and very reward
ing. Of course, all the responsibilities that fall to a business owner
are part of the deal. For many young dentists, the freedom to shape
their dental practice is more than enough reward for the level of
work involved in maintaining a day-to-day operation. Certainly, you’ll
be making a larger financial investment, so your debt load should be
considered realistically. Starting a practice, for all of the advantages,
means that your financial momentum will build more slowly even
while you devote a huge part of your time and energy to establish
ing yourself in the community you choose. Still, many an organized
young dentist has decided to hang that shingle and get to work with
the knowledge and belief that he or she alone can make or break the
practice.
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Practice Options
Advantages
• Ability to choose location
• Office design for specific,
personal needs
• Self-selection of staff
• Tailored marketing for your needs
• Use of self-selected equipment
• Being your own boss
Disadvantages
• Lack of practical knowledge
• Lack of money and assets
• Very little help and support
The Major Steps
1. Locate a site. Research practice locations by obtaining demo
graphic data from regional planning commissions, the Census
Bureau, and the local chamber of commerce. Study prospective areas
of growth, investigate real estate availability and prices, look into
schools and sense of community, use any personal and professional
contacts you have to gain insight, and check sites for leasing/buying
dental office space.
2. Negotiate a lease. Determine needed leasehold improvements,
check local zoning ordinances regarding signage and types of
business allowed in the designated area, and ask about anticipated
changes.
3. Obtain financing. Secure personal credit reports, develop a
written business plan that includes projected income and expenses
for the first years of practice, prepare a personal financial statement,
and calculate net worth in terms of capital available to cover start-up
costs. Visit financial institutions to begin shopping for a credit line
or long-term loan. In addition to the loan amount, pay strict atten
tion to two related factors: interest rate and length of amortization.
Lender/sellers generally charge lower interest rates than do lender/
institutions. Amortization refers to the time period (years/months)
over which the loan is repaid. If you need help with a business plan,
then get it. Trained dentists are not always business savvy, but a great
business plan can make your financing options work.
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Few dentists have ever
left school with their
futures carved in granite.
Those who did were able
to do so because they
had tangible goals and
plans.
Practice Options
4. Design an office layout. Attend a dental office design course
or seminar to learn planning principles, project anticipated practice
growth in the first five years, determine the number of treatment
rooms required by the third year, write down a design program to
describe immediate space needs and needs three years out, engage
a designer and have him or her begin space planning, and submit a
bank package with prices for design and construction. Look for wellknown, respected design professionals who understand the specific
needs of dentists and dental patients.
5. Purchase equipment. Seek quality and avoid “knock-offs” to
save money at first. Over time it pays to go with name brands whose
quality has been proven in the practice environment. Don’t overbuy;
while you don’t want the cheapest equipment around, you don’t need
all the latest bells and whistles either. The middle ground delivers all
the basic needs to delivery quality dentistry.
Conversely, don’t underbuy. Forecast your needs for the future. You
will need enough basic equipment to take the average new practice
into its third year without overtaxing the budget. The array of hightech equipment today is mind-boggling. Just remember that only the
successes with all this new-fangled equipment are publicized and
marketed. Failures are seldom mentioned, particularly by sales repre
sentatives who sell the equipment. While some of the new equipment
is practical and efficient, some of it is also unnecessary for quality
dentistry. Caveat emptor!
6. Hire and train staff. Perhaps the biggest mistake new dentists
make is hiring untrained employees because they don’t cost much.
You figure you can train them on the job, but in reality, that may
not be feasible. It’s better to borrow money to afford the quality you
need in the first person you hire because he or she will be integral
to where your practice is in one to five years from start-up. Choose
good staff members based on their dental experience, enthusiasm for
the work and the job, their level of empathy and caring, their attitude
toward being team players, and organizational skills (e.g., attention to
detail).
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Practice Options
7. Market yourself. Every modern practice needs to market itself.
All that really means, first and foremost, is knowing your “audi
ence”—the people in the community in which you decide to practice.
First, you want some demographic information about the dentists
and citizens around you. This include numbers on population density
from one to 10 concentric miles out from the practice, dentist density
from one to 10 miles out, physician density from one to 10 miles
out, the ages of the population in a 10-mile circle around your office
site, the percentage of population in each age group, average income
of families within 10 miles of the office, and major industries in the
local area.
8. Build office protocols and policy. This can get complicated
over time, but start with the basics and build from there. There
are many resources developed by dental organizations that you
can purchase and put to good use. These include letters, office
protocols, and billing policies. In the beginning, pay particular at
tention to production, or the amount you charge on a daily basis;
collection, or the amount you take in daily from patients and
insurance companies; hygiene production, one of the key profit
centers in a dental office; new patient referral and follow-up; the
cost of doing business, or charges, payments, and accounts receiv
able; major operating expenses and cash flows; and planning for
upcoming expenses.
Then there’s the less tangible but no less important protocol
involving how your practice is perceived by patients. Ask yourself
whether your protocols and policies encourage or discourage a
smooth operation from the time a new or current patient calls for
an appointment to the last step they take before leaving. Every
decision you make related to the patients’ level of comfort and
satisfaction adds value to your practice, from how people are
greeted at the door to how long they sit in the chair for treatment.
The best way to ensure that a high standard of care is being
provided is through written office protocols and policy, which
should be regularly discussed at staff meetings and updated as
needed.
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Chapter 3
Business
Organizations
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Chapter 3
Business Organizations
An Umbrella of Protection
A practice organization is essential to protecting yourself—and
others—from exposure to liability, debt, and unnecessary taxes.
Whatever form of organization you chose, you will always be respon
sible for your own negligence, and, if in practice with a partner or
co-stockholder, you may also be responsible for their negligence. It
depends on the state in which you are practicing. You can, however,
limit exposure to other types of debt by deciding on a business
organization form that is considered legally distinct from the practice
owner. Once you’ve decided where you want to practice, it’s a good
idea to contact that state’s dental regulatory agency and obtain a copy
of the state dental practice act for specifics. If you have an accountant
in mind, particularly one with tax expertise, consult him or her on
the types of dental business organizations and the characteristics of
each before making a decision on the form.
Minimizing taxes, which is a priority for any businessperson, is an
important part of any practice organization you choose. Basically, you
accomplish this by ensuring that income from the practice is taxed
in the lowest possible tax bracket or that losses generated by the
practice can be used to offset other income to the maximum extent
possible. Losses, for tax purposes, result from operating the practice
with a negative cash flow but can also be generated from deductions
that are available from various mechanisms, such as depreciation.
Regardless of the type of practice organization you choose, the ability
to use losses is subject to strict limitations laid out in the Internal
Revenue Code. So, the trick in choosing a form of business organiza
tion lies in determining which form will enable you to accomplish
both of the above objectives or the one that is most important to you.
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Practice Organization Types
In the context of dentistry, there are four types normally used:
• sole proprietorship
• partnership
• corporation
• limited liability company
In general, four major characteristics define the type of organization
you choose: management control (how business management is
distributed); financial liability (who is liable for financial obligations);
taxes (how business income is reported and taxed); and duration
(what happens to the business when the owner sells or dies).
The best advice for choosing a business organization is this: Get a
reputable accountant first. Yes, it will cost money upfront and if you
are leaving school with significant educational debt, as many new
practitioners do, it will be a tough decision. But keep in mind that
the money you spend now will be money saved in liability and taxes
(and then some) later on. You have to spend money to earn money,
a successful businessman once said, and generally that holds true in
any business. Of course, you want to stay within your budget, and
it can be a risky concept for those not skilled in business, which is
why spending money on a dentally savvy accountant is a good initial
investment. More words of advice from seasoned dental CPAs: Hire a
payroll firm to handle compensation distribution. Why? Practices
today often hire temporary employees provided by dental staffing
agencies. When a payroll firm handles a dental practice’s compen
sation, the firm knows all of the rules and the loopholes, thereby
protecting dentists and their practices from getting dragged into tax
complications, mainly over who is responsible for paying taxes on
work-for-hire employees. Yes, this is another initial cost, but one that
accountants say could pay big dividends and help you sleep at night.
If you do not have someone specific in mind, or don’t know where
to turn initially, a good place to start is the Academy of Dental CPAs
(ADCPA). ADCPA (www.adcpa.org) member firms have dental clients
in all 50 states and all have extensive experience with dentists and
their practices. Dental CPAs know the current laws and the configura
tion that would work best for you, given the details of your practice.
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“Learn the business side of
dentistry but know your
limitations and surround
yourself with trustworthy
experts.”
Terrence Yu, DDS
Palos Verdes, Calif.
Meharry Medical College,
2001
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Chapter 3
Don’t let pride get in the way of working with someone who knows
the ropes, particularly when you first enter the often-cutthroat business
world. Good advice is just a mouse click away, so take advantage of it.
You can, of course, also get sound business advice and referrals
through your professional organization, be it the Academy of General
Dentistry or another one. Once you’ve made contact, be patient and
ask as many questions as you need to achieve a comfort level. If you
don’t understand a concept, get it explained again. Why? Because
you’re not buying a car or a hand piece, you’re essentially buying a
business partner who can help make or break your practice. It’s also
a good idea to get references from experienced practitioners who are
satisfied with their CPAs and have been for some time.
Most dentists still
practice as sole
proprietors because it
gives them more
freedom from
government regulations.
They are truly
“their own bosses.”
Sole Proprietorship
In the case of a sole proprietorship, there is no distinction between
the owner of the practice and the practice itself. In other words, the
owner “is the practice” in the eyes of the law. The owner, then, is
liable for all debts that arise in the course of conducting the practice.
This can include debts for salaries, rent, supplies, and injury claims
that occur as part of the practice. If the practice does not pay such
debts, or does not have adequate insurance to cover them, creditors
can make a beeline to any practice assets in your name.
In contrast to a corporation, a sole proprietor does not pay corporate
taxes but, rather, pays personal income tax on the profits made,
which can make accounting a lot simpler and less costly. While a
corporation or partnership would need to submit a tax return the
size of a small book, a sole proprietor simply prepares a Schedule C,
which is attached to and filed with his or her personal income tax
return. Thus, if the practice makes a profit, you pay taxes on that
profit at your own tax rate. If the practice operates at a loss, then you
may be able use the losses to offset other income (subject to limita
tions in the Internal Revenue Code.)
Most dentists still practice as sole proprietors because it gives them
more freedom from government regulations. They are truly “their
own bosses.” As a sole proprietor, for example, you don’t have
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withholding tax obligations with respect to your own salary, but you
must pay estimated taxes and self-employment tax. The fact that
income gain or loss by sole proprietors is reported on their personal
tax returns is considered an advantage by many solo practitioners
because losses can be offset by income gains.
Currently, the maximum federal individual income tax rate, as well
as the corporate rate, is 35 percent. Since these rates are the same,
you can eliminate this factor when comparing the relative advantages
and disadvantages of limited liability and other business forms com
pared to sole proprietorship. Potential advantages of sole proprietor
ship are noted above, the greatest being your complete autonomy and
control. Potential disadvantages include difficulty in raising capital or
with bank financing. Hiring employees also can be more challenging.
And, if the sole proprietorship is sued, the proprietor is liable. Finally,
the sole proprietor is “the business,” a withdrawal from the business
or death means the business ceases to exist.
Many solo practitioners who have seen their business grow have
also seen their risks grow along with their success. Often, they are
advised at some point to form a limited liability company (LLC).
This limits certain liabilities that could occur, but the practice is still
treated as a sole proprietorship in terms of income tax accounting.
Partnership
A general partnership operates like a sole proprietorship, but more
than one person owns the practice. The legal definition is “two or
more persons engaging in business together to make a profit.” The
partners in a general partnership are typically co-equals in the
ownership and management of the partnership. Each partner can
act with full authority on behalf of the partnership and as such
must act in good faith. These co-owners are personally liable for all
of the partnership’s debts and obligations. A creditor can pursue
any partner for money owed as a result of the partnership’s debt.
That partner, in turn, can make a claim against the co-partners of
the practice and the liability for debt gets spread around. However,
having to face a liability that was not incurred by a partner and then
suing one of your partners to recover is not one of the healthiest
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Chapter 3
“This is definitely valuable
practice organization
information—for any
dentist about to begin private
practice, as well as for those
dentists with many years of
practice experience.”
Tim Menke, DDS
Cherokee, Iowa
University of Iowa, 1977
events that a partnership can have. This is one of the major pitfalls of
a partnership and why very few partnerships exist in dentistry today.
As a pass-through entity, profits are passed through to the individual
partners. Usually a partnership agreement spells out the manner
in which profits and losses are shared by the individual partners.
Another important fact to consider when deciding on your practice
business form is that a partnership interest is fully transferable and
can be sold, gifted, or bequeathed. Although, in a professional setting,
this transfer would have to be to another dentist, it might not be to
the dentist of your choice. The partnership agreement must address
this situation to avoid the possibility of a sticky situation. One poten
tial benefit of this arrangement is that liability is handled by more
than one person; the potential risk is that since all partners are fair
game, your risk decreases proportionately.
A general partnership is as easy to form as a sole proprietorship.
There’s no written contract required, but if you plan to enter into a
partnership, it is prudent to agree on and sign a written document
spelling out how profits and losses are determined and shared. Such
an agreement also will spell out voting rights, limitations on the way
the partnership interest is transferred, and all rights and obligations
that arise due to death, disability, or retirement of a partner.
One difference in partnership compared to sole proprietorship is the
requirement of an Employer Identification Number (Form SS-4), even
if there are no employees besides the partners. The general partner
ship, as a whole, is required to file an income tax return (Form 1065),
but the partnership does not pay the tax. Rather, each partner receives
a report that specifies his or her share of the profit or loss generated
(K-1). Currently, the tax rate for partnerships is the same as the
rate in sole proprietorships. For tax purposes, partnerships serve as
pass-through entities, so the profit, or net income, is divided according
to the partnership agreement and is taxed at the individual level. Each
partner then uses the report to fill out his or her own individual tax
return, similar to the way Schedule C works in a proprietorship.
Tax issues, such as withholding taxes and payment of quarterly
estimated taxes, are handled in the same manner that sole proprietor
ships are handled.
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Corporations
Corporations are creatures of statute, or legal entities that have a
separate legal identity from the people who make up the corpora
tions. A corporation that conducts a professional practice must
comply with the specific requirements of the professional corporation
statute of each state in which the practice is to be conducted. This
usually involves filing a document, called Articles of Corporation,
with the pertinent state agency, or official, and by taking other steps,
such as adoption of bylaws, election of officers, and stock issuance.
One or more person can own the stock of the professional corpora
tion, and the ownership is usually limited to people who practice
the type of professional service the corporation conducts. Usually,
corporations are identified by the words “professional corporation,”
“professional association,” or “chartered,” or by the abbreviations P.C.
or P.A. as part of its name. Once formed, a professional corporation is
generally considered separate and distinct from its owners in the eyes
of the law. This means that the practice is conducted by the corpora
tion and not by the owners of the corporation. The owners are the
stockholders, who vote to elect directors who, in turn, elect officers
who carry out the day-to-day operations of the practice. In a closely
held corporation, the stockholders, directors, and officers are usually
the same person.
A professional, such as a dentist, is liable for acts of negligence even
if the practice is incorporated. But the owners are shielded from
debts other than those that stem from professional negligence. Even
when the debts do not arise from negligence, the shield of limited
liability can be lost under certain circumstances:
• if the corporation is not operated as a separate entity.
• if the corporation is used to commit fraud.
• if the corporation violates federal and state statutes.
• if the owners voluntarily agree to guarantee debts, such as rents
and loans.
• if the corporation fails to pay certain taxes, such as withholding taxes.
Taxes are determined by how a corporation is set up within the stat
utes of the federal government and, sometimes, the state government.
A professional corporation has two choices for tax purposes: a “C”
corporation or an “S” corporation.
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Advantages of the
C corporation include
the provision of certain
tax-free fringe benefits
to stockholders who are
employees. Those include
tax-free health insurance
and tax-free group-term
life insurance.
The “C” corporation: This form is a tax-paying entity that must file
Form SS-4 and obtain an Employer Identification Number (EIN). It
also must file a federal income tax return Form 1120 or 1120-A and
must file a state income tax return. If the C corporation has a profit
at the end of the taxable year, it must pay income tax on that profit.
If it has a loss, it uses that loss to offset either past years’ income or
future income. In any case, it does not pass that loss on to its stock
holders. Profits of the C corporation are calculated by deducting from
its income all allowable expenses, as well as depreciation and amor
tization. Allowable expenses include the reasonable compensation
of stockholders/employees. Whatever is left over is taxed. Under the
Internal Revenue Code, professional corporations are taxed at a flat
34 percent rate.
The “S” corporation: If it has been an S corporation since its incep
tion, this is not a tax-paying entity. Like a partnership, or limited
partnership, the S corporation passes profits and losses through to its
stockholders, who report the profits and losses on their own income
tax returns. Still, the S corporation must obtain an EIN by filing form
SS-4. It also must file a federal and state income tax return. The fed
eral return is Form 1120-S. The corporation then gives stockholders a
K-1 form, the same as in a partnership, which reports each stockhold
er’s share of the profit or loss. Then, the stockholder transfers that
information to his or her own income tax return. Unlike a partner
ship, there is no ability to specifically allocate items of profit and loss
among the stockholders. Since the S corporation passes its profit and
loss to the stockholders, profit will be taxed at the individual tax rate,
while losses are available for use against other income of the stock
holders, provided that certain rules are satisfied.
C versus S: The most obvious difference is that the income of a C cor
poration is taxed, while the income of an S corporation is not, at least
under federal income tax laws. Instead, shareholders of the S corpo
ration pay income taxes on their proportionate shares of the profits.
Advantages of the C corporation include the provision of certain tax-free
fringe benefits to stockholders who are employees. Those include tax-free
health insurance and tax-free group-term life insurance. The C corporation
gets a deduction for the amount of premiums paid. The stockholder does
not have to include the value of the premiums in income.
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Chapter 3
If you are interested in an S corporation, there are certain pitfalls of
which you should be aware. The S corporation can only have individ
uals, estates, and certain types of trusts as stockholders. It cannot be
a subsidiary or parent of another corporation and cannot have non
resident aliens as stockholders. Strict ownership guidelines under the
S form require that an S corporation must be formed as such from
the outset, an election must be filed with the IRS within 2½ months
after the earliest date the corporation first has assets, issues stock, or
conducts business. It also must file Form 2553, which, if filed late,
delays the S designation until the corporation’s second taxable year.
The S corporation stockholders need to be very careful to establish
that they have “basis” if they intend to use the losses generated by the
corporation. Basis generally means what a stockholder pays for his
or her shares, plus loans made by the stockholder to the corporation.
Loans made by a bank or other third party cannot be used to estab
lish basis, a costly error often made by S corporation stockholders.
This error opens them to liability to the lender as a result of sign
ing personal guarantees; this is as much as they would have if they
borrowed the money directly from the lender and then lent it to the
corporation.
The clearest advantage to the S corporation versus the C corporation
is that since the C corporation is taxed as a separate entity, there
is double taxation of corporate income and dividends to share
holders. In an S corporation, since all income is passed directly to
shareholders who include their share on individual tax returns, the
S corporation can bypass the double taxation. The accounting for an
S corporation can be easier as well. That advantage must be weighed
against the aforementioned restrictions placed on S corporations and
the fact that there can be serious tax ramifications if the S corporation
is subsequently changed to a C corporation.
Choosing to operate as a corporation requires the weighing of its
advantages against its disadvantages. Help with this exists in the form
of your certified public accountant or attorney. They are crucial mem
bers of the team, not only for tax reasons, but also for their overall
business knowledge. This would be an appropriate time to use their
skills.
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“The factors that you use to
decide which of the business
models you want to use should
be guided by a professional.
Make sure you have a CPA
who has dental practice
experience so you can focus
on your dental team and
the patients you serve to get
the most joy out of being a
dentist.”
Bruce Burton, DMD, MAGD, ABGD
Hood River, Ore.
Oregon Health & Science University, 1980
3
Chapter 3
“It will be to your advantage
to select an accountant, a
lawyer, and a banker when
setting up a dental practice.
Experienced dental colleagues
Basically, the advantages of incorporation are:
1) There is a reduction in self-employment taxes.
2) Fringe benefits are deductible:
a) health insurance
b) life insurance up to $50,000
3) There is limited personal liability except in the case of malpractice.
4) There are increased after-tax earnings on investment income.
in your community may be
helpful in choosing these
important professionals.”
William E. Chesser, DMD, MAGD
Ozark, Ala.
University of Alabama School
of Dentistry at UAB, 1967
The disadvantages of incorporation are:
1) There is a decrease in retirement contributions.
2) Taxes can be greater:
a) increased unemployment taxes
b) increased employment taxes on spouse
c) increased taxes on corporate profits versus noncorporate profits
3) Costs of incorporation can be high:
a) initial cost involved with incorporation
b) ongoing costs of operation
4) Sales of the corporation are more complex.
5) There is no income splitting in a professional corporation.
These advantages and disadvantages must be carefully analyzed
for each individual’s needs and only then can a decision be made.
Corporations still have a place in dentistry, but there are other
options that must be evaluated.
Limited Liability Company
As you’ve probably noticed, the acronym LLC is increasingly com
mon in the title of dentists’ practices and for two good reasons. As a
hybrid between a partnership and a corporation, the limited liability
company (LLC) offers the “pass-through” of business income in a
partnership with the limited liability of a corporation, or the best of
both worlds. Once highly limited state-by-state, LLCs are simple to
form as long as there are at least two members. It’s always wise to
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consult with an attorney first to see if this form of business organi
zation is available in the state in which the practice is located and
which stipulations might be involved since they vary state-by-state.
Since the 1990s, however, when the first LLC legislation was passed,
most states have adopted LLC statutes that permit health care profes
sionals to organize their practices as such.
An LLC typically insulates its owners from liabilities resulting from
business operations, but the LLC members (owners) are still liable
for their own negligence. They are not personally liable for general
debts of the business and also are not liable for the negligence of their
co-members.
From a federal tax perspective, the LLC can qualify to be treated
exactly like a partnership, meaning that although it must file income
tax returns, it will not be a tax-paying entity. Rather, profits or losses
generated by the business are passed through and reported by the
members on their own income tax returns. These profits or losses are
determined by the value of the member’s contribution to the LLC
unless the operating agreement determines differently. This operating
agreement is the bible of the business and must be carefully crafted,
again with the help of a knowledgeable attorney. At the same time,
because the LLC also shields the members from nonmalpractice
liabilities like a professional corporation, it can be more useful than
either a general partnership or an S corporation. It can make more
sense than the S corporation, for example, because the members can
make special arrangements among themselves regarding the sharing
of profit and loss, which they can’t do in an S corporation without
negating its status. Dentist members also have far less to worry about
over loans that are made directly to the LLC. And, dentists buying
into the practice, or being bought out, can avoid certain tax problems
they face in the corporate context.
In a nutshell, the partnership tax treatment represents the main
advantage of the LLC over a corporate form of business. Both provide
limited liability, but this pass-through of income in the LLC may tip
the scales in its favor.
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Chapter 3
There are some potential disadvantages of the LLC business form:
• Many states levy a franchise tax or capital values tax, meaning
basically that the practice pays the state for the limited liability
protection it receives. Make sure you check with an attorney in the
state in which you want to form an LLC.
• It can be difficult to raise capital in an LLC. More conservative in
vestors often prefer to throw their money at the clearer corporate
form.
• Governance of an LLC can be tricky since LLCs are required to
have boards or officers.
• All income is subject to FICA tax because all members receive
income taxed at their individual rates.
In Summary
Although this discussion perhaps leads to more questions than
answers, the previous information does narrow the range of choices.
The LLC, if allowed in your state of practice, does appear to offer
many advantages not offered by the other forms of business. Its
governance, although more complicated than a sole proprietorship, is
far less than a corporation. Its pass-through capability while main
taining limited liability decidedly definitely swings the pendulum in
its favor. Although the S corporation offers both of these advantages,
incorporation is far more complicated and costly to start and main
tain. There are a few benefits lost, but these are not usually the ones
used by dentists in their operations.
However, all states operate differently, and, as usual, it is always
prudent to consult with your attorney team member before making a
commitment.
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Chapter 4
Systems
Development
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Chapter 4
Systems Development
The Mighty Mouse
“Going from dental school to
practice is a significant step.
Take as many quality courses
as you can. Each will give you
tips and ideas that will guide
you in your transition from
dental school to private
practice. Ask questions of
peers who share your
philosophy. Be honest, do the
best dentistry you can, and
As part of the first fully digital generation, you probably think of
computers and software when the words “systems development”
come up. It’s true that more and more dental practices are without
paper, pen, and film. As computers became as ubiquitous as leaves on
a tree, their costs came way down. At the same time, dental software
developers were fine-tuning their programs to actually reach a level
of technological seamlessness that became a buzzword before it be
came reality. Yet, while many dental practices today are wonders of
modern technology, computer hardware and software are really only
efficient mediums. In its broadest sense, systems development refers
to the organization of your practice into logical modules that can be
repeated easily and without mistakes, day after day. It’s a sensibil
ity that is shared by the doctor and the entire staff and reinforced
daily. And it’s a way to be consistent so that most of your time and
attention can go toward the most important aspect of your practice:
patients.
always put the patient first!”
When you begin a practice, it’s always wise to execute a blueprint
that lays out your systems, how they will operate, and what they will
Peter G. Sturm, DDS, MAGD, FADI, CDC
accomplish. Any veteran dentist will tell you that working out bugs
Spokane, Wash.
in records maintenance, collections, continuing care, and inventory
on the fly will likely leave you frustrated and frazzled in short order.
AGD Associate Editor, 1996 –
As is said repeatedly throughout this manual, planning and foresight
will help make your transition to practice as seamless as your tech
New York University College of nology. Pulling together your daily operating procedures is no differ
Dentistry, 1972
ent. A word of caution from the get-go: As tempted as you may be to
have the latest and best technology in your practice, from the front
desk to the operatory, slow down. Don’t go out and buy everything
under the sun—it takes at least a few years to build up your practice,
and the more you can put back into the “nuts and bolts” of the prac
tice the first few years, the better.
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Systems Development
Chapter 4
Chart Maintenance
(Documentation)
Without accurate charts you are working blind, so a system for
treatment records is extremely important from the first day of
practice. Needless to say, a system for chart maintenance will fulfill
the essential need for accuracy. It’s generally recommended that
dentists keep records indefinitely and certainly for a minimum of 10
years. Every state is different, but some states make you keep records
for life and some for just a few years. It is important to check your
state’s practice act.
If your records are electronic, that can be as easy as a backup system
that automatically records all information from a particular day and
transfers to a disk for safekeeping off-site. Patient records include any
radiographs, written clinical notes, models, photos, and so forth. If
you get to the point of wanting to dump some documentation, consult
with your professional liability carrier before saying good-bye to any
patient records. Patient records are required by law to avoid charges
of professional misconduct, so be careful out there—and make sure
you consistently review charting with your dental team members.
Proper organization of charts, whether on paper or on computer,
should include:
• All doctor and patient remarks.
• Radiographs.
• Prescriptions.
• Lab slips.
• Letters and other correspondence.
• Referrals.
• Forms.
Necessary forms include:
• Medical history.
• HIPAA.
• Patient record (if written copy).
• Financial arrangements.
• Signed treatment consent (informed consent).
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If payment collection
is where the rubber
meets the road,
appointment control
and scheduling can be
considered the axle that
holds the tires.
2
Chapter 4
Systems Development
Rules for writing in charts are straightforward, but they should be
followed exactly for every patient and in every case. Keep these
tips in mind:
• Never, ever, alter a chart.
• Always write legibly.
• Update medical histories promptly when needed.
• Be sure that date of entry coincides with the schedule.
• Strive for consistency.
• Chart all noncompliance, but avoid derogatory remarks.
• Follow up with phone calls for difficult or invasive procedures.
• Chart alternative options for treatment.
• Chart negative outcomes.
• Do not make financial entries in the chart.
Always document your referrals concisely but completely.
When referring to colleagues, in every case, send copies only of
chart notes and radiographs and include any written requests for
information.
When referring to specialists, include treatment limitations. Also,
take the opportunity to establish a relationship with all of the
specialists to whom you refer patients. You can use these relation
ships to assist with practice building.
When referring to attorneys, include copies only, written requests
for information, depositions, and compensation information.
Report potential lawsuits to your carrier immediately. (Remember:
You are in default if you fail to file a response to a lawsuit within
30 days of service.)
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Systems Development
And, speaking of attorneys, here is the profile of a typical plain
tiff:
• Eighty-nine percent are female (a typical practice is 60 percent
female).
• Ninety-one percent are over age 55.
• Plaintiff is often employed in the health care industry.
• Spouse or friend usually brings patient to appointment.
• Plaintiff has been in your practice less than one year.
• Plaintiff is a patient who feels he or she is being ignored.
• Plaintiff is a patient who comes to your practice complaining
about his or her previous dentist. (Be aware this patient may be
hard to please from the get-go.)
Here’s advice on how to respond to an irate patient (and avoid
litigation):
• Redo the work at no charge.
• Pay another dentist to redo the work.
• Refund the patient.
• Don’t be afraid to say, “I’m sorry I didn’t meet your expecta
tions.”
Here’s how to handle adverse treatment outcomes:
Your obligation in the event of an adverse outcome is to immedi
ately advise the patient and communicate openly. You also must
make referrals as required or provide specific instruction on the
monitoring of future treatment of the resulting condition. This
can be awkward, and when the patient is naturally nervous or
emotional, can lead to an immediate claim. Failure to immedi
ately inform the patient, however, is a breach in the standard
of care and opens you and your practice to successful litigation.
Above all, be proactive when something goes wrong. That way,
you minimize your risk of having a claim made against you and
you maximize your defense in the event of a claim. Your defense
will always be bolstered when you have used proper verbal and
written informed consent (recorded on the chart), made informed
consent routine (being candid enhances your credibility and mini
mizes your liability), and advised the patient immediately (noting
this on the chart).
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Accounts Receivables/Collections
From your first day of practice, good records are important. Each pa
tient should have a ledger record kept for charges, payments, and bal
ance. These records can be maintained with a good Peg Board system
or a computer. Always accept credit cards for payment. This makes it
easier and more convenient for your patients and enhances the image
of your practice as flexible and accommodating. Choose two or three
credit card options that your practice will accept; you do not need to
take all types of credit cards.
Accepting credit cards also will help you in the long run to become
knowledgeable about your patients’ insurance carriers and how to
process forms with each carrier so you receive timely payment. An
effective billing system that generates statements each month for
each patient with a balance will help you keep a handle on what you
are owed. From the start, make sure that you and your entire team
understand clearly your rules for collecting payment from patients.
Always have payment arrangements in writing so that there is no
confusion between staff and patients.
A good financial policy:
• Establishes goodwill with patients.
• Motivates patients to fit dental expenses into their monthly bills.
• Tells each patient exactly where he or she stands.
• Collects a higher percentage of accounts.
• Makes payments due on a specific day of the month, not on the day of the
appointment.
• Puts a system in place to collect past due accounts. This system, often a
phone follow-up approach, kicks in before the account becomes delinquent.
• Has a system in place to collect when all else has failed (e.g., collection
agency).
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Systems Development
Chapter 4
Knowing the Numbers
While a collection system is where the rubber meets the road in
terms of your practice “success,” tracking other numbers is equally
important to the bottom line. The numbers you need to know at all
times include production, hygiene production, new patients, followup, payroll, laboratory expenses, supplies, rent, utilities, and tele
phone.
Production, of course, is the amount you charge on a daily basis.
A dental practice is selling its time, and this figure enables you to
measure the productivity of your time. Hygiene production is known
as a “profit center,” or the source of dollars generated in the practice
by providers other than the dentist. Since hygiene is a big one, it’s
important to monitor the effectiveness of your staff in providing a full
hygiene schedule daily. The most effective way to track this daily is
to develop a form into which numbers can be plugged and accumu
lated.
One aspect of your numbers that may slip through the cracks is
new patient referral because it appears less tangible than others.
It’s important, however, to know if your various efforts are bringing
new patients to the practice and whether you retain them. Again,
by developing a standard form, you can more easily keep track of
patients by documenting dates, names, information sent to the patient
before the first appointment, whether an appointment was made and
kept, whether a second appointment was made and kept, the referral
source, and whether a thank-you note was sent to the referral source.
Operating expenses, or the cost of doing business, can be tracked
with another form month-to-month. The numbers to be plugged in in
clude charges, payments, accounts receivable balances, new patients,
hygiene patients treated, and major operating expenses, such as staff
payroll, dental supplies, lab costs, and rent.
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Some will argue
that the best dental
consultants are dentists.
But that great clinician
may be a lousy
accountant. There are
non-dentists from many
walks of life who are
great advisors.
Chapter 4
Systems Development
Appointment Control
“Systems are great. Technology is wonderful. But systems and technology are good only for what they allow you to accomplish with that other If payment collection is where the rubber meets the road, appoint
ment control and scheduling can be considered the axle that holds
the tires. Good scheduling and appointment control can generate
a constant, manageable flow that works for your practice and your
dental team, practically eliminating scheduling snafus and tightly
controlling your production and profitability.
system with which you will As mentioned earlier, computer hardware and software have come a
long way since the days intrepid dentists were just trying to get them
system hasn’t been updated to work without glitches. Electronic schedulers, for example, are now
for many, many years and it’s just one module in a bigger package of bundled practice management
software. Developers of such software consider it to be the hub of
the most complex system in everything that happens in the practice. Today, four popular dental
your office: It’s the system management software programs alone have more than 40,000 users
that comes attached to the combined. Estimates are that between 80 and 90 percent of practic
teeth—the human being. In all ing dentists are now using electronic scheduling. A little more than
of the talk of technology and 10 years ago, about 10 percent of offices were using the technology.
materials and systems, the fact The most popular brands of practice management software all can
be customized to fit the specific needs of any office, so it makes sense
that there’s a person on the other end of those teeth can’t to check out systems in place at established practices you admire. If
another practice fits a scheduling profile you would like to follow, get
be forgotten.” details on what the practice uses and how it is employed.
deal in your practice. This Bruce M. Scarborough, DMD, FAGD
Natchez, Miss.
If you’re going to use an electronic system, which is likely these days
based on the statistics above, it becomes immediately important to
know what you actually need and with whom you’re dealing. This
University of Mississippi School means understanding what hardware is required, how much sup
of Dentistry, 1989
port you’ll receive from the company (because you’ll need it at some
point), and how long the company has been around.
That doesn’t mean that a relatively new company, or even a start-up,
is incompetent, but that companies with longer track records are
much easier to assess. You can weed out many companies right away
by looking at data, such as the number of users, the number of years
a company has been in business, and the level of technical support
a company provides. And while you’re at it, be sure to get a handle
on the frequency and cost of upgrades. Some software systems seem
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Systems Development
to require upgrades every week. Since you don’t want to spend more
time than is necessary on that aspect of your practice, so you can de
vote time to the patients themselves, a little up-front homework can
help you to determine if you’re about to enter an update nightmare.
Other aspects of the system to consider are its ability to accommo
date multiple users, its cost, the amount of training involved (and
whether a company will provide it), the location of the training
(Will trainers come to your office?), the number of training sessions
needed, any video support, the ability to process electronic claims,
and its complexity. Unless you are the type who can take a mother
board apart and put it back together, you do not want a system that
you don’t fully understand.
Modern scheduling and appointment control software should include
the option to use and customize many modules. Basic patient fields
include:
• Prefixes for sending letters.
• Medical alerts.
• Insurance information.
• The date of the last prophylaxis.
• The last medical history update.
• The last continuing care visit.
• The last full mouth X-ray series.
• The last hygiene X-ray series.
• The head of household.
• Separate recall and billing address.
• Broken appointments.
• Special messages.
• Social Security numbers.
• Emergency contacts.
• Date of birth.
Advanced patient fields include:
• Multiple address and phone
number capability.
• Multiple employer tracking.
• Account balances.
• Patient marking.
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•
•
•
•
Appointment tracking.
Referral tracking.
Multiple insurance tracking.
Comment fields.
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Systems Development
Other modules include those for fees, insurance, transactions,
reports, and scheduling. And don’t forget the good old telephone,
which still has a lot of life left in it. The phone can be highly effec
tive as a marketing tool and information center, so predetermine how
many lines you might need and how the phone can be integrated into
seamless scheduling and appointment control.
Controlled scheduling has been shown to increase profitability by
flagging the most productive procedures; enabling scheduling based
on an average daily level of production; maximizing the potential of
each chair in the operatory; enabling separate scheduling of dental
assistant time for better production; enabling shorter scheduling
increments, which saves up to two weeks of treatment time per year;
enabling schedulers to confirm appointments at least two days in
advance, which reduces hygiene no-shows and last-minute cancel
lations; enabling new patient scheduling within 10 days of their call
while their motivation and interest are high; and enabling a scientific
approach to patient management with lots of flexibility built in.
Continuing Care
In the proverbial nutshell, continuing care means regular professional
visits by all patients in your practice. Easier said than done, certainly,
but much easier with a continuing care system in place. First, you
need to head back to dental school and to the first principle you were
taught: Most dental disease is preventable and easily treated if caught
early. Most patients who regularly return to their dentists for “check
ups” probably limit the context to cleanings and oral exams. But a
good continuing care system uses that time to motivate and educate
patients on the leading edge of preventive care and new concepts in
dentistry. Besides, if you’re taking continuing education classes as
suggested, you are going to continually improve as a practitioner and
it behooves you to do everything you can to ensure that your patients
benefit from that improvement.
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Systems Development
Make no mistake, you need to put some thought and effort into a
continuing care system. It’s not simply a matter of telling Mrs. Smith
that you hope to see her in six months or telling Mr. Smith that it was
wonderful seeing him and wishing him all the best. Like an appoint
ment control, or scheduling system, a continuing care system also
can help you and your dental team maximize your efficiency and
avoid downtime. If it helps, think of the acronym FEM to keep you
on the beam: The importance of continuing care lies in its
financial (F) implications to your practice; educational (E) opportunities
to apprise patients of new developments, techniques, and philosophies
of care; and marketing (M) your practice through a vehicle that allows
you to put your best foot forward and show each and every patient
that you care about them as individuals and recognize that they have
complex lives of their own. More than any other facet of their success,
continuing care systems rely on a total commitment by the doctor
and staff. That means, day in and day out, the practice embodies its
continuing care philosophy and applies it in its patient treatment. If
it’s half-baked, it’s going to look as though the bottom line is what’s
important to you, not the patients. Do it right and the income will take
care of itself.
As noted, the vast majority of dental practices today employ com
puterized practice management software that includes scheduling
and appointment control. Once you’ve found hardware and software
that works for you, your continuing care system can be part of the
scheduling and appointment control system, whereby you collect
and collate important demographics (who are your patients, where
your patients live, etc.) that paint a good picture of your patient base,
including their needs and motivations. Once in place, the system
should:
• Motivate each patient at the end of each appointment.
• Pre-schedule the next appointment.
• Send a card two weeks in advance of the appointment.
• Confirm the appointment to lessen no shows and last minute can
cellations.
In order to perform these tasks, your receptionist or other office staff
are going to need time, so be sure to build this time into your daily
scheduling so they can do it right.
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Chapter 4
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Chapter 4
Systems Development
Inventory Control
“It is critically important not to
incorporate too much
complexity when you
begin designing your practice
systems, as this can be
overwhelming and
confusing for both the doctor
and staff. Start with good solid
building blocks and progress
from there. You don’t have
to do it all at once. A strong
foundation will lead to an
outstanding future for you
and your practice.”
R. Claire Campbell, DMD, FAGD
Clackamas, Ore.
Oregon Health & Science
University School of Dentistry,
1996
The choice of materials, knowledge of material properties, and an
organized, systematic approach to inventory control are essential for
the smooth function of any practice. The number of products you
use in each category depends on your needs, level of skill, the type
of practice, and the costs involved. In other words, use whatever
materials with which you are comfortable, but make sure you do use
them. Having cabinets full of leading-edge products you don’t use is
a waste of your time and money, so stick with what you know and
expand your inventory as your practice grows. A lot of good dentistry
can still be done with some fairly basic materials and techniques, so
avoid letting the temptation for the “new” cloud your judgment.
The key to inventory control is to have your staff involved. Designat
ing a staff person as your main purchaser and inventory monitor can
pay dividends, especially as that person grows into the job and knows
your materials backwards and forwards. As the saying goes, two, or
even three, heads are better than one, particularly when it comes to
keeping track of what you need and when you need it. So make sure
your staff is keenly aware of what you use and how often you use it.
Together, you and your staff can keep close tabs on your inventory,
helping you to buy only what you need to keep the practice running
smoothly. While this isn’t exactly the “on-time” approach to inven
tory taken at hospitals, where materials managers responsible for the
ebb and flow of everything from tissues to endoscopes fine-tune their
operation to have only what is needed in stock to save money, it is a
facsimile of that approach in terms of philosophy. Stockpiling materi
als without knowing what you have and whether it is needed will
surely help your inventory spin out of the control. So know what you
have at all times.
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Systems Development
Developing a Checklist
The best way to know that you are on top of your materials is a
checklist. It’s a straightforward process, with the only trick in the
beginning, when you shape your list by appointing certain products
to categories. Once you have the categories arranged, it’s a matter of
using the checklist regularly, as in noting each material used and how
much of it you have left.
Typical categories include:
• Acrylics/reline materials.
• Anesthetics.
• Liners.
• Cosmetic materials.
• Endodontics.
• General operatory supplies.
• Hand pieces and accessories.
• Impression materials.
• Instruments.
• Preventives.
• Small equipment.
• X-ray.
•
•
•
•
•
•
•
•
•
•
•
Alloys.
Cement and liners varnishes.
Cosmetic/esthetic.
Disposables and accessories.
Finishing and polishing.
Gypsum.
Impression accessories.
Infection control and accessories.
Pins and posts.
Rotary cutting.
Sutures and suture needles.
Systems
As touched on previously, the system you have in place to keep track
of inventory is as important as the inventory itself. But more than
anything, a good system is simply a matter of application and rep
etition. You and your staff should follow the same protocol for the
use of all materials, such as including the recommended minimum
quantity on your checklist and notating their use each time. After a
while, the process is almost second nature because you can rely on
your team and your inventory control system to do most of the work.
You simply need to stay on top of it and repeat it over and over.
As your practice grows and changes, so too will your inventory. By
constantly tracking what you use and how much you use it, you’ll be
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Chapter 4
Systems Development
able to chart quantities needed in your storeroom to ensure that your
“on-time” inventory approach stays in place.
“We are the respected leaders
within our particular dental
environments from whom
employees seek support and
guidance. As leaders, our
goal is to ensure that our
‘dental team’ maintains a
focused solidarity while
Keep in mind that when you’re starting a practice, it’s easy to become
absorbed by your work and your patients’ satisfaction with the over
all operation. You might be tempted to get to the inventory “later.”
After all, it’s all in the same place and it’s not going anywhere.
Don’t kid yourself: When you’re starting a practice, sometimes on a
relative shoestring, you need to pay close attention to all aspects of
the practice that cost you money. A lack of attentiveness to inventory
right from the start can create an inventory monster. You think you
know what you have and what you need, but you could be mistaken.
Human recall is a funny thing; sometimes it works very accurately
and sometimes it fools you into thinking you know when you
actually don’t. The only way to know for sure is through a hands-on
inventory control system that keeps your team involved—and with
some simple but time-consuming counting, and sorting. The time you
spend will more than be paid for by the money you save by avoiding
the purchase of quantities you’ll never use.
steadfastly adhering to the
highest professional standards
in the treatment of patients.”
Bill Chase, DDS, FAGD
Cathedral City, Calif.
University of Detroit Mercy
School of Dentistry, 1972
Remembering Recall
A cornerstone to building your practice will be an effective hygiene
program. The hygiene department should generate 33 to 40 percent
of your practice production. If you ask, “Why the variance?”, it varies
based on the type of practice you have. If your practice does a great
deal of crown-and-bridge work, then the figure will be lower. If your
practice is mostly fillings, then hygiene will be higher. No matter how
you would characterize your practice, hygiene is essential to your
productivity and success.
Though maintaining a schedule for each patient’s periodic exam and
cleaning should be a no-brainer, you’d be surprised at how many
clinicians don’t do it systematically. It’s not that they think it’s a bad
idea. Rather, their practices may be flourishing and patients may
be lining up to see them. Under these circumstances, recall may be
placed on a shelf for a rainy day. But it’s always better to have a sys
tem in place than to wait until your practice needs an obvious lift.
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Systems Development
These visits are the backbone of every dental practice because pa
tients who are committed to ongoing, regular care are the best ones
to have. They are content with their continuing care and thus are
likely to refer their relatives and friends. It’s a classic win-win situ
ation. As a responsible clinician, you have the opportunity to get to
know each patient and his or her wants and needs, and this fosters
education and two-way communication.
Hygiene visits also give dentists the opportunity to market to patients
of record. It’s a great time to tell them of new advances or showcase
new concepts or technology. It continues to reinforce the bond that
doctors develop with patients. The payoff comes when we advise
them of work that must be completed and they readily agree to
follow up.
Informed patients are generally happy, satisfied patients. Tell them
you’ll see them in six months and you probably will. Patients who
are on a recall system better understand why they need to return
regularly and the health benefits they accrue in doing so. If nothing
else, recall is a pure form of marketing that emphasizes caring and
service—two elements that your new patients will want, appreciate,
and even demand.
A successful recall system depends on the commitment of staff mem
bers and the doctor. Without a day-in and day-out commitment to it,
it won’t work in the long run, because a lax approach will increase
the chances of something going wrong.
An effective hygiene program necessitates that the patient’s next
appointment be made in advance. Without a commitment from the
patient to keep the appointment, it is likely that he or she will be lost
in the cracks by the staff—the patient will forget to come in or they
won’t perceive a need to follow up with the hygienist.
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Whatever bells and whistles you decide to attach to your recall ap
proach, a successful system must answer the three “Ws” of continu
ing care: when, what, and why.
There’s no shortcut to
building a truly great
team—you have to
commit to spending time
on all of the systems that
make up your office.
When. Time intervals for recall have to be customized to patient
needs. Many adults increasingly need to be seen every three to four
months rather than every six months. Many times a patient will have
wonderful teeth with no decay but will need constant periodontal
supervision and need to come in more frequently to clean their
teeth. Perhaps this patient needs to come in every three months for
a prophy and, on the six-month visit, to receive a prophy with an
examination. It is possible that the patient needs to see a periodontist,
and you would like the patient to alternate visits with you and the
periodontist. With their oral health maintained more often, these pa
tients tend to respond with higher commitment to the schedule and a
desire for more dentistry.
What. Each visit encompasses various combinations of services for
each patient. Custom scheduling helps ensure that the patient gets
the care he or she needs, in addition to a more productive hygiene
schedule. Essentially, when scheduling an appointment, consider
what the patient needs. Not every adult needs an hour for a hygiene
appointment. You ultimately dictate how much time is needed—not
the hygienist or schedule coordinator.
It’s all about
communication,
communication, and
more communication,
which takes times and
Why. What motivates each patient to return? That’s what you need
to know. The “why” is communicated during the hygiene visit, while
scheduling ongoing care and recall follow-up. Everyone wants to
know why. If it is their periodontal condition that is deteriorating,
then stress that. If it is decay or existing restorations that are break
ing down, then stress that. Give patients a sound reason and their
motivation to maintain a recall schedule will increase.
consistent effort in order
to be effective.
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Systems Development
Staffing
You’ve probably heard this certain saying over and over, but it bears
repeating even if it makes you swoon: “You can’t do it alone.” Build
ing and maintaining an excellent dental team is vital to your practice.
Any dental practice management firm will tell you that the dental
team, in fact, is the heart and soul of your practice. You team spends,
by far, the most face time with your valued patients and spends the
most energy “reading” those patients to gauge their needs, wants,
and desires. An unhappy or unfulfilled team member is a crack in
the foundation that can cause the whole house to collapse. It’s also
safe to say that the dental team is doing more than ever around the
office and the operatory. Patients are more demanding, technology
is prolific, procedures are expanding, and coordination of the dental
team is the only way to keep all of the balls in the air. They say the
devil is in the details. Successful dentistry is about far more than just
clinical procedures these days—your team can greatly help, or hinder,
the ongoing juggling process.
“The greatest joy and stress comes from how well your office team
works together,” says AGD Past-President Bruce Burton, DMD,
FAGD, ABGD, in an article published in the September 2006 issue
of AGD Impact. “The relationship you have with your team sets the
tone of how patients perceive their care. Patients pick up on whether
there’s tension or a lack of communication between staff.”
Longtime dental management consultant Cathy Jameson says, in the
same article, a great dental team is a “group of leaders working cohe
sively toward a common set of goals.” But first, each member needs
to be a leader of him- or herself. “They each need to decide if they
are an asset to the practice,” she says. “Nobody can make anybody
else be productive.” Second, the team members must lead one an
other, so that the team as a whole can determine goals in accordance
with the vision for the practice, and team members can rely heavily
on one another through constant support and reinforcement of a reli
able and replicable system.
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The basics of any workable system include:
• A daily commitment to be on time.
• A daily commitment to be prepared.
• A daily commitment to minimal interruptions.
• A focus on the patient.
• A focus on communication (in-person, telephone, e-mail, letters, etc.).
“Many dentists want to go
hide in their office and hope
the conflict goes away. There
is a fine line between that and
getting too involved, so be
there for your entire staff, but
teach them to deal with issues
by utilizing your well-setup
systems.”
Carolyn Taggart-Burns, DDS
Omaha, Neb.
University of Nebraska College
of Dentistry, 2002
There’s no shortcut to building a truly great team—you have to com
mit to spending time on all of the systems that make up your office.
Each person needs to know his or her roles in the different systems
and how he or she can support other team members. It’s all about
communication, communication, and more communication, which
takes time and consistent effort in order to be effective. For some
new dentists, that means learning to deal with conflict as it arises
in myriad forms. The alternative, being conflict-adverse, generally
means that the team is left to work it out themselves, but team mem
ber are usually unprepared to do that alone.
Communication comes from discipline that has everyone adhering to
your systems and the way they operate, day after day. A dental team
that works together for the practice and the patients has regular staff
meetings in which all team members have the chance to talk about
how and where their skills and personalities complement the entire
operation. To that end, a good team goes over each day’s schedule to
anticipate what each member’s roles will be and how each member
can assist another. In addition, it helps greatly to go over the previous
day’s schedule as well, to talk about what went right and what could
have gone better. How often you have meetings depends on your
practice and the comfort level you have with your team. Logic dic
tates that with a new team, you probably need to meet more often,
perhaps even every day until the operation is running smoothly. With
a highly experienced staff, perhaps you only need one big meeting
each month. It’s up to you to determine the frequency needed to help
the team adhere to your systems.
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When it comes to successful meetings, consider the following:
• Were all of the projects assigned?
• Were all of the projects prioritized?
• Did all of the projects have completion dates?
• Were all of the team members present?
• Did everybody participate?
• Did anybody dominate?
• Was everybody up front and honest?
The doctor’s schedule for each day also should be reviewed ahead of
time to minimize glitches that slow the operation down. Often, that’s
a matter of asking some pertinent questions:
• Have confirmations been made on all patients?
• Are the lab cases ready to go?
• Have emergency slots been identified, just in case?
• Have vacant slots been identified, just in case?
• Have you identified stressors, such as difficult cases, difficult pa
tients, and scheduling challenges?
• Have you identified and prepared for staff birthdays, staff anniver
saries, patient referrals, and so forth?
“The great thing about being a general dentist is that there are lots of
ways to run an office,” Dr. Burton says, “from the dentist who likes to
have his or her hands in everything to the dentist who is more com
fortable delegating to a staff that is highly trained and trusted.“
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Hiring and Firing
It’s been said that the biggest mistake new dentists make is hiring
untrained, inexpensive employees. If you must, borrow more money
as part of your office loan to afford the right first hire’s salary. This
person will help determine where your practice will be one year and
five years from now.
Qualifications and characteristics of an excellent first team member
include:
Experience. This person may be your only employee when you start
up, so experience is a big advantage, particularly when it comes to in
surance claims, presentation of fee skills, and knowledge of scheduling.
Enthusiasm. This person could be your patients’ first contact on the
phone and upon check-in. Passive employees create passive results.
Empathy. You want employees who show empathy and concern for
others. Their attitude should be “we’re here to serve you” as opposed
to “we’re doing you a big favor.”
Team attitude. All for one, one for all. Team members leave their
personal problems and their egos at the front door before they come
in to begin the day. Everybody is human, and so, everybody has bad
days. But a pervasive team attitude will keep the operation moving
smoothly and forward.
Organization skills. All employees should have an attention-to-detail
spirit, meaning each is willing to take a share of the responsibility.
When it comes to your first employee, this means working toward a
full appointment book, seeing that all insurance is filed promptly, that
accounts are constantly monitored closely, and that accounts payable
are paid on time.
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Letting an employee go can be tricky and touchy. With clear commu
nication and adherence to all applicable policies, however, the process
doesn’t have to be all bad. Here are a few pointers:
• Keep accurate documentation.
• Review all records pertaining to the fired employee.
• Assess the timing of the firing.
• Conduct an exit interview, in which you clearly and briefly articulate the
reasons for termination. You should have an office manager present to
provide a witness to what was said.
• Wait until the end of the work day to break the news.
• Consider how long the employee has worked for you. The longer the
employment, the greater the need for a higher level of proof of poor
performance.
• Review what was said in the most recent employee evaluation.
• Conduct a careful investigation before termination.
• Make sure the job description is consistent with reasons for termination.
• Know your state’s employment laws, or at least ask your lawyer for the
basics.
Chapter 4
“In my experience of reviewing
dental claims of various kinds
for more than 18 years, the
difference between a good
restoration and a failure is
about 2 minutes. The extra
time you take to check
preparations will result in
better treatment for your
patients. Remember, if you
All these points add up to one big one: When you terminate an
employee, follow the system you have in place for hiring and firing.
Make sure you develop it before you see your first patient, rather
than winging it as staff problems occur. A plan that covers contin
gencies also will help you to avoid a termination that violates public
policy.
If you feel you must terminate an employee for the sake of your
practice and other team members, you should have a history of evalu
ations in place. Employee evaluations put you and your employees on
notice as to how the job is being performed.
To be useful, and many are not, employee evaluations must have sub
stance, objectivity, and candid assessment. In addition, they should:
• Include subjective comments, which tend to be more accurate than
predetermined categories, such as “excellent,” or a number rating.
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care about your patients, they
will take care of you.”
Michael D.L. Weisenfeld, DDS, FAGD
Greensboro, N.C.
University of Michigan School of Dentistry, 1963
0
Chapter 4
“Remember your staff is an Systems Development
• Include the employee’s strengths and weaknesses, emphasizing
how you believe his or her performance can be improved. Although
you may be reluctant to criticize because you want an evaluation to
be a positive motivational tool, constructive criticism can be caring
and positive while helping an employee be a better team member.
extension of you. This will • Be consistent. This means reviewing prior evaluations so that the
parameters in the future include problem areas in the past. In other
words, if the first review notes a tardiness problem, the second
the long run, you will benefit review should note whether or not the problem has been corrected.
tremendously. Patients are very cost you in payroll but, in savvy to a ‘happy, cohesive office.’ Make sure your staff understands your philosophy, and it’s critical that you lead by example. Good communica
tion between you and your staff leads to a bond that greases all of the wheels. Patients want an environment that leaves a positive impres
sion on them—not once, but every time.” Michael L. Bydalek, DMD, FAGD
Horsham, Pa.
Temple University School of Dentistry, 1989
Consultants
Not everyone needs a practice management consultant, but you
might. If you do decide you could use some help, the right consultant
is a good long-term investment that can alleviate a lot of unneces
sary stress. Consultants come in many flavors. Practice management
consultants will typically take a rounded view toward the practice,
providing a foundation in each of the areas that require your at
tention. Some are specialists. You can hire bankers, certified public
accountants, an insurance agent, a financial planner, or a retirement
expert. Your advisors also can include an attorney and a dental sup
plier. Knowing whom you need—and when—is your job, so do your
homework and be honest with yourself. There’s nothing wrong with
asking for help. Dental practices are complicated businesses, as well
as sources of health care. Coming out of school, you can’t be expect
ed to know everything. Finding a good consultant, whether for the
practice as a whole or for specific aspects of your operation, can be
challenging, but less so if you stick to some parameters.
Determine what’s wrong as relative to your practice goals. Take a hard
look at your immediate and longer-term practice goals. Do you know
where the practice stands financially? What are your production lev
els, collection ratio, accounts receivable balance, and overhead?
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Focus on the issue. A big mistake new dentists sometimes make is letting
themselves be overwhelmed by the big picture. Specify what the prob
lem is in your practice. Sometimes, there are problems in many areas,
and sometimes one major problem is the source of other problems.
Match the specialist to the specific problem. Generalists are fine,
especially when you’re setting up your practice and need to take a
rounded look at where you’re heading. But if you have a tax problem,
an experienced CPA is the answer. If you have legal concerns, then an
attorney is the best bet. Match the advisor to your needs.
Conduct a thorough search. Create a reference file in which you can
compare what you find. Some consultants are invited to speak and
present seminars across the country. Can you hire one of them?
How much experience does a consultant have? Do they have solid
references? The best bet: Identify a practice you admire and ask the
dentist/owner who his or her practice management consultant or
specialty advisors are.
The consultant doesn’t need to be a dentist. Some will argue that the
best dental consultants are dentists. It’s just common sense, right?
Not necessarily. If you need clinical help and advice, an experienced
dentist may be just the ticket. But that great clinician may be a lousy
accountant. There are non-dentists from many walks of life who are
great advisors.
Don’t expect a consultant or advisor to do all of the work and make
everything better. The best consultants will readily tell you that they
are essentially members of your dental team, nothing more, nothing
less. That means that you as the dentist/owner must be fully invested
in the process, whether it is in regard to the clinical or organizational
aspect of your practice. A consultant is only as good as the dentist
with whom he or she works. Good consultants don’t carry magic bul
lets that promise to make problems go away while you concentrate
on seeing patients. A consultant is an investment in both time and
money, so make sure that you stay intimately involved in order to
understand all of your options.
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Laboratory Functions
According to Ricki Braswell, CAE, many dentists are “unaware that
in 47 states dental technicians work without minimum standards and
governmental regulation” (AGD Impact, September 2006). >>
Working with Dental Laboratories and Technicians
Gordon Christensen, DDS, PhD—founder and director of Practical Clinical Courses, an international continuing education organization for dental professionals based in Provo, Utah—provided some valuable insight on the current state of the dental laboratory community and tips on how to select a dental laboratory in the July 2006 issue of AGD Impact. Dr. Christensen is one of the most respected, and blunt, advisors in dentistry. AGD: What credentials should you expect dental laboratory technicians to hold?
GC: My personal goal is to have more technicians with Certified Dental Technician ratings. I want to enhance and improve the status and influence of these ratings. In Western Europe, many technicians have earned Master Technician credentials, but that requires several years in school and the successful completion of an exam. I would love to see American dental laboratory education move to that level.
AGD: Do laboratories provide warranties for completed restorations?
GC: I have never worked with a laboratory that has provided a documented warranty, but I know such war
ranties exist. The guarantee of good work has always been implicit and directly linked to my personal rela
tionship with the technician. Again, there has to be mutual respect between dentists and technicians. Some laboratories present a form saying that restorations are guaranteed for a specific number of years. This is only necessary if you have an antagonistic relationship. Building and cultivating strong personal relationships establishes the best warranties because dentists and technicians will then have a mutually vested interest in the outcome.
AGD: How much turnaround time is standard for a completed restoration?
GC: Two weeks is an adequate amount of time for a completed restoration. However, there are times when treatment has to be completed in a day or two. In those cases, the delivery date should be agreed upon ahead of time.
AGD: Why do some dentists work with more than one laboratory?
GC: Some dentists work with more than one laboratory because different laboratories may offer different expertise or different services. Some dentists choose a laboratory based on price. They may choose a lab that does the least expensive work even if it is at a lower level of acceptability. Other dentists really do not mind paying three times the national average for higher quality restorations. The average dentist is looking for de
cent quality and a moderate price. If these elements are met, dentists typically stick with the same laboratory.
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Dentists use different measures to determine a dental technician’s
skill. According to Braswell, “Some consider the fit of the final prosthe
sis, some consider the function, and still others consider the form—but
most dentists consider all of these. Yet, regardless of the importance of
these three variables, they only measure skill, not competency.” >>
AGD: What role should price play in selecting a laboratory?
GC: I have conducted studies with many laboratories across the country and discovered that there is little correlation between price and quality. A high-priced laboratory does not always equate to high quality work. Dentists should look for quality, and they should endeavor to establish personal relationships. Once these elements are in place, price can be negotiated.
AGD: Does size really matter? Are larger laboratories better than smaller ones or vice versa?
GC: The disadvantage of working with a large laboratory is that it will likely be remote from your of
fice, and therefore, not allow for much personal involvement. Many dentists prefer smaller laboratories because they can have personal interaction throughout the process. However, both small and large laboratories can provide good quality restorations.
AGD: Is there particular equipment that all labs should have?
GC: Soon, all laboratories will need to own or have access to milling devices for zirconium-based restora
tions. The industry is headed in the direction of using computer-aided milling equipment.
AGD: Is it necessary to conduct a site visit before beginning a relationship with a laboratory?
GC: I think it’s highly beneficial for dentists to visit laboratories to observe the control, cleanliness, count
ing orientation, décor, and employees in the lab. Dentists should also note the level, cleanliness, and quality of the materials and techniques used.
AGD: Should you work with laboratories that outsource work? If so, under what conditions?
GC: Sure, but you should make certain that you know to where the work is being outsourced and what metals are being utilized.
AGD: Is there anything else that you should keep in mind when selecting a dental lab?
GC: The dental laboratory industry is in a definite state of crisis because of outsourcing, the lack of edu
cation for technicians, and the lack of interaction between technicians and dentists. The industry needs to address and resolve these issues.
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She notes, “A skilled technician has the ability to create a prosthesis
with an appropriate look and fit, which are good traits for a restora
tion; however, a competent technician incorporates those necessary
skills with the ability to work with the appropriate materials for the
prescribed restoration, the knowledge to critique the process along
the way, and the means to provide quality control. The competent
technician knows not only how a prosthesis is created, but why cer
tain materials are used, and under what circumstances the materials
will best perform.”
Reasonable expectations of lab work will suffice for most dentists,
but even expectations can be confirmed one of two ways, according
to Braswell. One way is trial and error, which may not make you the
most popular dentist on the block, or you can work with a certified
dental technician (CDT).
With well-defined systems in place, your practice will run much
more efficiently. Take the time to set up your systems. Taking the ex
tra time at the beginning to get things in order will save you frustra
tion and time in the long run.
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Chapter 5
Marketing
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Chapter 5
Marketing
Using the “M” Word
Whether you consciously intend to market your new practice or not,
rest assured that marketing will be part of your practice. Once com
monly disdained by dentists as an excuse for less than stellar clinical
results, marketing is simply a way of telling your patients, prospec
tive patients, and your community about yourself and your practice
philosophy. That way, “consumers” can make informed choices about
the dentists they choose to see and can feel comfortable in knowing
that they share their dentist’s perspective. You are not telling people
that your dentistry will cure the common cold or make them famous.
In a practice that uses marketing, you are making claims that reflect
your standard of practice and your commitment to quality dentistry
for all patients.
Know Your Audience
Take the time to do your
homework. You can’t
market to your audience
if you don’t know your
audience, and the better
you know it, the better
you’ll be able to
fine-tune your efforts.
The first rule of any marketing plan is to know the audience receiving
your messages. Before you institute a formal plan, search for informa
tion on population density from within one to more than 10 miles
around your practice (concentrically). You need to have an audience
close by, as the law of proximity will tell you every time. You can then
break down the local population according to age, and what percent
age of the total population is in each age group. Try to learn income
levels of families in your concentric circle and look into major indus
tries in your area. What type of insurance do those businesses carry?
Try the local Better Business Bureau or your Chamber of Commerce
for statistics and demographics on your local population.
(Remember that, despite the numbers, there will be natural barriers
that prevent some people from coming to see you. It may be an area
of town that many would prefer not to drive through. There may be
slow-moving traffic patterns or ongoing traffic construction delays in
your area. These barriers tend to discourage some people from com
ing to your office. It doesn’t mean they won’t come—it merely makes
marketing to them more challenging.)
Likewise, determine how many dentists are practicing from within
one to more than 10 miles away from your practice. Competing for
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Marketing
patients is a fact of life, so you may as well know who your competi
tion is and what they have to offer. One of the best methods is to buy
a large map of your area (check with the local planning commission)
and use different colored pins to identify each group. And, since
referrals may come from physicians in the same area, it doesn’t hurt
to have knowledge of the local physician base.
Take the time to do your homework. You can’t market to your audi
ence if you don’t know your audience, and the better you know it,
the better you’ll be able to fine-tune your efforts.
Chapter 5
“Just be certain that you
keep track of your budget
for marketing, and that you
use those dollars in the most
effective way possible. Tracking
the results is the only way
Methods of Promotion
to know if your efforts are
There are two basic types of marketing—internal and external—al
though they often overlap in a conscientious marketing approach.
Internal marketing implies marketing done within the office by
utilizing the existing patient base. External marketing utilizes meth
ods outside the office (telephone advertising, newsletters, direct mail,
etc.) that are designed to reach potential patients.
mistake that I did. The first
Internal marketing. For any dentist, whether right out of school or
in practice for 20 years, the most cost-effective marketing technique
is word of mouth. This is always your best marketing tool because it
requires virtually no expense, is easy to accomplish, attracts patients
who are many times similar to the ones who you already have, and
usually brings in patients who have already “bought in” to both you
and your practice philosophy. Particularly in a society so highly tuned
to consumerism, the way you practice and provide your services can
be a windfall or a death knell. In other words, while your restorative
work may be impeccable, your prickliness may be enough to send a
patient away forever. While your office may be clean and inviting,
your receptionist and her constant complaining will be what is
remembered most. It’s the entire package—from environment, to
service, to clinical skills—that will market your practice effectively.
When a patient who leaves your office is impressed with each
element of the practice, he or she may rave to a neighbor or relative.
You can see that this type of marketing has the potential to exponen
tially increase your patient roster.
of my practice, no one used
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successful. Don’t make the
Next
year, I bought a practice and
put a small ad in the four
phone books that contacted
me. My budget was spent, and
I didn’t realize that, in the area
three of the four books!”
Cindy T. Flanagan, DDS, FAGD
Houston, Texas
University of Texas Dental
Branch at Houston, 1989
Chapter 5
Marketing
Types of Internal Marketing
• Telephone
• Atmosphere
• Staff
• Efficiency
• Caring Attitude
• Calling
• Writing
“Marketing takes many
forms and has many diverse
applications. And while
not all types of marketing
are required, desirable, or
necessary for all practices,
the fact of the matter is that
marketing in dentistry is
essential.”
Eugene Antenucci, DDS, FAGD
Huntington, N.Y.
New York University College
of Dentistry, 1983
To paraphrase a time-honored saying, the whole of these elements is
greater than the sum of the parts. This isn’t a menu, but a discipline.
If you do one, you should do the rest because each is fueled by the
synergy of the others.
The people answering the telephone should be pleasant, caring, and
courteous. The patient calling to inquire about the practice, or just
calling to make an appointment, will remember that encounter, good
or bad. You never get a second chance to make a good first impres
sion.
The utilization of scripts is almost required to form a consistent, pre
ferred image. Scripts are comprised of written dialogue and answers
that your staff can follow when talking with patients on the tele
phone. For example, your staff should always answer the telephone
by saying, “Thank you for calling Dr. Smith’s office. My name is
Sherrie, how may I help you?” By following this protocol consistently,
your staff will become comfortable with the script and will genuinely
reflect the attitude you desire.
Front office positions are some of the most difficult and demanding
jobs in the office because they require development time, integration
time, and follow-up. Many dentists find training employees in these
positions to be difficult and will thus hire a dental consultant to help
them. Although costly, a consultant can head off many potential prob
lems. In general, remember to keep scripts simple.
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Chapter 5
Marketing
Once the patient has agreed to come to the practice, the atmosphere
he or she enters should shout “professional.” Details do count in a
dental office. That means keep your office neat and clean. Remove or
replace any torn or worn-out furniture. If possible, there should be
comfortable areas of seating. This allows the feeling of privacy in a
nonprivate setting. The judicious use of plants and flowers is a rela
tively inexpensive esthetic improvement. Magazines should reflect in
terests of the market you are in, as well as the market that you would
like to attract. Magazines should be up-to-date, and keep in mind
that there is such a thing as too many magazines. There also should
be cosmetic dentistry books that show patients the type of work that
your office can provide. And, as your practice develops, it would be
beneficial to develop your photography skills to develop—and show
case—a book of your own work.
One of the most relaxing items you can have in a dental office is a
fish tank. This tends to mesmerize children and entertain adults. Be
sure that the tank is facing your patients and is properly maintained.
If space allows, a video game system for children and teens also is
a nice touch in the waiting area. Perhaps you can even designate a
section for small children, complete with toys. These are all wonder
ful ideas, but they require appropriate space and consideration of the
needs of all of your patients.
All patients should be greeted by the receptionist or business assis
tant when they come to register. Your hand-picked staff should be
friendly, sincere, knowledgeable, and attentive. It’s easier for them to
be that way when they sincerely enjoy working for you. This means
that staff training is essential, and ongoing training is a must. It helps
employees put their best foot forward if they have books and audio
tapes to consult, not only for their own learning, but for use with
patients who need and want clear, definitive information.
Staff meetings should be frequent and structured to ensure that
everyone on the team is on the same page. Initially, these meetings
should be weekly for one hour. Once the team is trained, the fre
quency of these meetings can be reduced to semiweekly or monthly.
Remember, staff meetings are crucial and should be held in the
utmost respect by the office staff. Each meeting should include an
agenda to assist with meeting structure.
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“Your biggest asset is you. Enjoy your work, and treat your patients and employees with respect and compassion. If you are sincere in these areas, then your patients will be your greatest marketing tool.”
Norman D. Magnuson, DDS, FAGD
Eugene, Ore.
Georgetown University School of Dentistry, 1982
0
Chapter 5
“Marketing forces us to look Marketing
Efficiency is noticeable, especially to today’s on-the-go patient who
may be seeing you during a lunch break. A dentist and staff conduct
ing the day’s business with attention toward a smooth process will
get noticed right away, as will an office that seems to be up for grabs.
Efficiency implies to the patient that you are knowledgeable and sure
of what you are doing. In a nutshell, it exudes confidence.
continually outward and keep our practice in step with the anticipated environment. With ongoing marketing in a professional manner, a dental practice will continue to thrive.” Cheryl Bradford Billingsley, DDS, FAGD Richmond, Va. Medical College of Virginia, 1990
Of course, efficiency includes moving patients in and out in a
timely, comfortable manner but without the sense that they are on
a conveyor belt, or being rushed. A caring attitude can manifest in
various ways, from concern over a procedure that is about to be
performed to compassion over the patient’s bedridden mother. The
key is communication. Unless you are a basset hound, your eyes will
not be enough to convey the deep sense of caring you follow in your
practice. While we all have different personalities, everyone can learn
to communicate directly and precisely. One of the simplest ways to
communicate with others is to place yourself in their shoes. Do not
be sympathetic to them—instead exude empathy. The old Native
American adage, “You don’t know a person until you walk in their
moccasins,” implies that we need to understand our patients in order
to fully communicate and be compassionate.
Show your patients that you care—a great crown placement isn’t
enough. Calling and writing fall into that huge area typically referred
to as “common sense,” but many young dentists who are trying to
build a patient base and keep a new practice running smoothly may
not see these actions as a priority. Yet, it doesn’t take a psychologist
to tell you how much calling or writing to patients means to them.
Patients recognize that you are taking the time to inquire despite your
busy schedule, and this will go a long way toward gaining their abso
lute trust. Your business staff should prepare a list of patients (with
their phone numbers) who have major procedures done (surgery,
crown, or bridge preparation, etc.) and you should call them after
work to be sure that they are doing well. Written thank-you notes
should always follow a referral of someone to your practice. These
are efforts that should become second nature to you and your staff.
External marketing. When a new dentist is first considering “mar
keting,” this is the type of marketing that typically comes to mind.
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Marketing
Chapter 5
External marketing includes Yellow Pages ads, community involve
ment, and school-based oral health education. Whichever form of
external marketing you use, the common denominator is to have
it be ethical and “dripping with class.” Your state’s laws on dental
advertising determine the rules for marketing that dentists must
adhere to. Of course, your objective is to draw individuals unfa
miliar with your practice to it.
First, you must recognize that there are people drawn by mar
keting and some who respond negatively. Within the group that
responds to marketing, there are many subgroups, including:
• those who assume that all dentists are the same and will re
spond only to price. Be careful of this group. There is, after all,
always someone who can and will offer services for less. Do
you really want to recruit this type of patient?
• those who respond only to “great deals.” They will come in to
take advantage of whatever special enticement you offer (inex
pensive cleaning, discounted bleaching, etc.). Unfortunately,
these special deals tend to be all that matters to them, and they
are not likely to become regular patients.
• those who will respond to special comfort, convenience, or
services you provide. These individuals do have the potential to
become regular patients.
These are all factors that need to be considered when evaluating
your marketing plan and budget.
Yes, by the way, you do need a marketing budget. One of the great
problems with external marketing is that much more money is
usually spent than a typical budget would allow. For most new
dentists, marketing should be no more than 5 percent of the bud
get. Remember, you still have equipment to pay off, staff salaries
to pay, rent that’s due, and many other expenses, so stay on bud
get! When you stray from the path, you pay the price.
That attention to the bottom line also means accounting for the
cost-effectiveness of the marketing plan. You should know how
much production increased as a result of an advertisement or
program. If you don’t, you have no way to gauge your market
ing plan’s effectiveness. Each type of marketing that you employ
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Each type of marketing
that you employ should,
at minimum, generate at
least three to four times
its cost. If it doesn’t,
you must reevaluate the
effectiveness of the
advertisement or its
necessity.
2
Chapter 5
Marketing
should, at minimum, generate at least three to four times its cost.
If it doesn’t, you must re-evaluate the effectiveness of the adver
tisement or its necessity. You will find with experience that most
external marketing does not generate a much higher return than
this amount. Sometimes you may find that you spent far more
than what the resulting production is worth. However, if you
don’t monitor the results, you will never know. Most dentists who
use external marketing do not have a grasp of this concept. The
best advice is to be diligent.
Marketing is two-thirds
internal and, maybe,
one-third external.
Your external efforts are simply an extension of your internal
efforts, which again grow from your professionalism, sense of
purpose, and caring for patients. While some dentists may shun
Yellow Pages ads, they may be perfectly suitable to your role as
a professional—as long as the ads are simple and truthful. An
ad should be seen as just one way to get a new patient into your
office to see the way you practice. Ads should never be used as a
way to sell dental procedures. Aggressive external marketing isn’t
going to result in lines of patients at your office door. In fact, if
it’s not low-key and professional, you could do your practice more
harm than good.
There are other ways to reach out to your community, and some
won’t cost you a cent. They will, however, require time and
devotion. Offer to write a weekly column on oral health for your
local paper. Volunteer to go into local schools to visit with school
children and teach them about oral health, such as proper oral
hygiene. (You also get to know the teachers who are invariably
appreciative of anyone who helps them to do their difficult job.)
Offer to speak at local luncheons held by business or benevolent
organizations, such as the Lions and Rotary Clubs. Be a frequent
speaker at local assisted-living facilities. Offer to be the local
dentist on call for hotels within a three-mile radius of your office.
Take local realtors and pharmacists to lunch; these are the people
who know their communities and keep in touch with many resi
dents. They can be incredible sources of referrals if you strike up
a sincere relationship with them. Probably the best advice is to
get out into your community and become an active participant.
People prefer to see a dentist who they have met before.
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Chapter 5
Marketing
Place respected books on dentistry at local businesses, such as
beauty salons and health clubs, with a sticker on the front that
mentions your donation of the book. Place a small pocket inside
the cover to hold your business cards.
Direct mail can be effective at bringing in patients, but the
method usually requires some type of enticement, such as a
reduced fee on a common procedure (cleaning). Remember that
the patient to whom this appeals is rarely one who will stay in the
practice. Even professionally done, this type of marketing rarely
yields more than a 2:1 return. Response to a piece is rarely above
1 percent and, again, it tends to attract a certain type of patient.
3
“I think developing a mission
statement and a logo for
marketing to establish a
‘brand’ is helpful. If possible,
hire a marketing specialist to
help with a marketing plan
for the area in which you
practice.”
The Golden Rule
David A. Tecosky, DMD, MAGD
Philadelphia, Pa.
Marketing is two-thirds internal and, maybe, one-third external. In
other words, it may take patients 10 years to realize you’re an excel
lent dentist, technically speaking. It may take them only 10 minutes
on the phone or in your office, however, to know whether they want
to return and if they will make a referral.
University of Pennsylvania
School of Dental Medicine,
1979
In Search of Excellence, a forward-thinking business primer by Tom
Peters, stresses that many businesses in the United States spend
millions of dollars on marketing and advertising, and you see their
names everywhere. Yet they are “failing miserably” because they
don’t spend time and money on training their staff to treat patients
with dignity and care on the phone or at the front door.
Another rule of thumb is a time-honored one: Treat current and pro
spective patients the way you would like to be treated. If you actually
would like to be treated badly, perhaps you’re in the wrong line of
work. If you would like to be treated with dignity and respect, at the
very least, then keep that in mind when dealing with your patients
and community. That’s not to say that you have to be a stand-up
comedian or Albert Schweitzer. If you’re a quiet, low-key person,
that’s fine. Caring comes in many forms, and patients will know
it when they see it—or feel it. The worst thing you can do is make
patients feel as though they are a walking set of teeth to be worked
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Chapter 5
Marketing
on. Remember: There is a complicated, feeling person attached to
that mouth, and he or she brings a persona to the practice, for better
or worse.
Don’t shy away from marketing—embrace it! Utilized correctly, both
internal and external marketing will benefit your practice greatly.
Determine the types of marketing your practice needs and then take
the necessary steps to implement them.
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Chapter 6
Financial Planning
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Chapter 6
Financial Planning
Debt Management The Problem
Owing money is nothing
new, but it has spun
out of control over the
past two decades as
consumers live as though
they’re all playing
Monopoly®.
Debt, along with the failure to set goals, is probably the most under
mining problem facing the new dentist. Its effects are dramatic and
long-term; debt can be is emotionally devastating. When we owe mon
ey, our personal image becomes shrouded in doubt and worry. Family
tensions increase dramatically as the debt level rises, sometimes lead
ing to marital discord. Even if you’re single, debt has a way of sucking
the pleasure out of your new practice and your life. Many new dentists
graduate from school with significant debt and you may be one of
them. The debt has been incurred for the sake of your future, but any
new debt from current practice can be controlled and even avoided by
following fairly simple rules that involve a lot of self-monitoring.
Debt is deadly because it has a one-two punch. While it causes
problems related directly to owing money, it also undermines the
goal-setting process that is so important to getting started in dental
practice. As debt implies, purchases and/or services must be paid off
in a timely manner. While you focus on the payoff, which usually
includes compound interest, you can’t employ the resources earned
for future use.
Owing money is nothing new, but it has spun out of control over
the past two decades as consumers live as though they’re all play
ing Monopoly®. People would rather go into debt to have big screen
televisions and new cars for the present rather than save for a sound
financial future. As a dental student, you have been faced with a dif
ferent type of debt—educational debt coupled with associated living
expenses while attending school. Many of you are married, and some
of you already have children, which exacerbates the problem. The
table below shows the debt that the average dental student carries
upon graduation.
Dental School Debt in 2004
School Debt
Female
$125,141
Male
$132,623
Other Debt
$ 70,195
$ 67,586
Total Debt
$195,336
$200,209
Source: American Dental Association, Survey Center. Surveys of Dental Graduates.
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Financial Planning
Even while you try to pay back your educational debt, you are more
than likely responsible for buying dental equipment, office space,
and start-up costs. This problem can easily affect your credit rating,
which not only determines if you can borrow money in the future,
but also plays an integral part in how much you pay in interest
expenses for the ability to borrow. Those individuals who are deemed
credit risks are restricted in many ways. Yes, you can bypass some
debt obstacles initially by associating with another dentist, but you
must remember that other issues are involved with that type of
practice, as discussed in Chapter 2.
You also may be looking for a place to live and spending money
on day-to-day living expenses, which can add up insidiously. New
dentists are not alone in facing debt. Dentists of all ages can easily be
caught in its trap. Remember that while the time you take to pay off
debt counts against your credit score, so too does the total amount of
debt that you carry.
Your credit score is an integral part of the debt issue, as well as your
overall financial health. There are several reasons to annually check
your credit score, including:
• Recognizing identity theft.
• Correcting inaccuracies.
• Evaluating areas that require improvement.
It’s also important to note that credit scores can on occasion be
wrong. If they are in error, then you need to correct them as quickly
as possible since they can have a dramatic impact on your borrowing
power. There are three main agencies mandated by law to provide
everyone with a free copy of their credit report annually. It is wise to
check each one.
• Equifax: (800) 685-1111 www.equifax.com
• Experian (formerly TRW): (888) 397-3742 www.experian.com
• TransUnion: (800) 888-4212 www.transunion.com
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Chapter 6
Chapter 6
Financial Planning
Good Debt vs. Bad Debt
If you are struggling to
pay your bills, or adhere
to a budget, stop using
credit cards altogether.
When forced to withdraw
cash or write a check,
you will probably rethink
the decision, possibly not
make the purchase at
all, or even purchase a
less expensive item.
All of your office-associated debt is loosely termed good debt. If it is
money spent to fund an activity that will generate income (i.e., dental
practice, real estate project, etc.) or that will create a tax deduction
(home mortgage), then this debt is worth evaluating, even incurring.
That doesn’t necessarily mean that going into a debt is a good deci
sion. It only means that you will receive a deduction on the interest
incurred. In other words, you won’t have to pay taxes on the interest
incurred for borrowing the money necessary to fund these projects.
Since you still must pay the money back on a certain timetable, incur
ring practice-related debt simply means that you won’t be adding
insult to injury.
Bad debt, or debt that we incur from consumer spending (vacations,
entertainment, appliances, cars, etc.) heaps taxes on the interest
payment. In other words, there are no tax deductions for bad debt.
If you consider what you earn in practice, certain operating
expenses are certainly incurred. For the average practice with a
well-established patient base, these expenses tend to run 65 percent
of production. This leaves you with approximately one-third of
what you earn to live on. As a new dentist, you do not have a fully
developed practice and you are paying for equipment, in addition to
trying to balance normal operating expenses. This usually increases
your expense basis to 80 to 85 percent, leaving you with very little
to live on. Normal living expenses will eat up the majority of these
remaining funds. If you have to pay back your consumer debt (bad
debt) or debt on a house mortgage (good debt), you will be doing
so with a very small piece of the pie. For every $1,500 to $2,000 of
disposable income per month, you must improve your production by
$10,000. Remember that you are left with only 15 to 20 percent of
your production income after normal business expenses. And that’s
the main problem with debt—it’s terribly difficult to pay back.
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Financial Planning
Rules of Engagement
So how do you get out of this quagmire? Basically, with determina
tion, a plan, and discipline. Unfortunately, this manual cannot pro
vide the determination and discipline, but it can help with the plan.
Step 1. Quit Spending. The first thing you must realize is that
spending is the problem. To rectify this, you must change your behav
ior. This means stop spending—period! Beyond basic living expenses
(and, no, plasma televisions are not basic), you must begin to save
money to pay the debt you’ve incurred. Unless you are independently
wealthy, there is some inevitable sacrifice involved in order to pursue
your chosen profession, and that’s where determination and a plan
come in.
Begin by eliminating your reliance on credit cards unless you pay
that credit card statement in full each month. There is an inherent
advantage to paying by credit card. Banks entice you to use their
cards by providing rebates and frequent flyer miles on airlines, which
can make for nice family vacations and reduced future purchases.
But, credit cards also enable you to spend money more frequently
than you would in a cash-and-carry world.
If you are struggling to pay your bills, or adhere to a budget, stop
using credit cards altogether. When forced to withdraw cash or write
a check, you will probably rethink the decision, possibly not make
the purchase at all, or even purchase a less expensive item. Paying
with cold, hard cash will always make you rethink your decision. If
you are following a budget carefully, the judicious use of a credit card
is acceptable—as long as the balance is paid off each month and no
interest charges are incurred.
Next, use a one-month cooling off period before making a non-essen
tial purchase. This means that the electricity bill and rent or mort
gage must be paid on time, but new furniture or a new car can be
put off. Once the cooling-off period concept is applied, you will talk
yourself out of non-essential spending because you are not blinded by
the emotion of the moment.
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Chapter 6
0
Chapter 6
“Professionals who do not
plan for their future are not
likely to have one. Follow the
basic and time-tested advice in
this chapter. It will allow you to
realize your dreams and ensure
the bright financial future you
have worked so hard for.“
Jeffrey M. Cole, DDS,
MBA, FAGD
Wilmington, Del.
AGD Treasurer, 2006 –
Georgetown University School
of Dentistry, 1986
Financial Planning
Equally important is acting like your tax bracket. Unfortunately, a
diploma is no guarantee of significant income, however unfair that
seems. You’re not assured of anything yet, though new dentists
are often drawn into the cycle of “keeping up with the Joneses.”
Remember, you are not entitled to anything as a dentist other than
what you accomplish yourself with determination and discipline. As
soon as you recognize this fact, you are on your way to success. So,
just because your friends are driving expensive cars, living in large
homes, and taking opulent vacations, that doesn’t mean they actually
have the resources to pay for it all. More than likely, it means they
will be working long hours after you have retired and are playing golf
every day. Live within your means and you will be rewarded in the
future.
Step 2. Prepare a Budget. By preparing a budget, you begin to
establish discipline that will be important in achieving your financial
goals. For starters, budgets often eliminate unnecessary expenditures,
because they are staring you in the face. Careful budgeting can create
20 percent more disposable income than occurs for those who do not
budget. The amount saved from budgeting alone often can be used to
pay off debt.
There are two budget forms that you must use. One is for your
personal life and one is for your practice. Pages 82 to 85 contain
sample budgets that can be used for each.
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Financial Planning
The first form is for a personal budget. It shows percentages for each
category and expresses a desired spending limit for that category.
Therefore, if you exceed the limit one month, your budget tells you
to spend less the next month to recapture that shortfall. You will
notice the last category of debt, which is designed to save money
that is used to pay off intermediate and long-term debt. This does not
include any new purchases. New purchases must fit into the catego
ries that you already have. This enables you to begin reducing your
debt load reasonably. If you are renting and are without a mortgage,
then the excess will go into the debt account to pay down those debts
more quickly.
You also will notice an entry for savings of 10 percent. This is a
standard rule of thumb that establishes a solid savings pattern for
the future. Initially, you will use this money for an emergency fund.
Do not confuse the savings account with a debt reduction account.
They are two separate items. Computer accounting programs, such
as Quicken®, will help you determine how much was spent in each
category.
You also will notice an office budget. Although this budget is
designed to show what the “average dentist” does, it can serve as a
useful tool for the young dentist to see where he or she has to go.
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Chapter 6
2
Chapter 6
Financial Planning
Personal Budget
Day
25%
Taxes
20%
Mortgage
10%
Savings
10%
Food
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Total
Budget
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7%
Auto
5%
Medical
Financial Planning
5%
Insurance
3%
Entertainment
3%
Utilities
Prev
2%
Other
First
10%
Debt
Next
Chapter 6
3
Chapter 6
Financial Planning
OFFICE BUDGET
Income:
Gross Income
Expenses
1. Supplies
a) Professional
b) Business
2. Laboratory Fees
3. Rent
4. Telephone
5. Repairs and Maintenance
6. Staff Salaries
a) Clerical
b) Assistants
c) Hygiene
d) Fringe Benefits
- Insurance
- Retirement
e) Payroll Taxes
7. Advertising and Promotion
8. Continuing Education
9. Utilities
10. Accounting and Legal
11. Travel and Entertainment
12. Contingencies
13. Other Expenses
1.00%
4.00%
2.00%
1.00%
1.00%
1.00%
1.00%
0.50%
2.50%
2.00%
Total Expenses
64.00%
Budget %
Income Projection
100%
Projected Expenses
7.00%
2.00%
8.00%
5.00%
1.00%
1.00%
6.00%
9.00%
9.00%
Profit 36.00%
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Financial Planning
Actual Production
Actual %
Difference in $
Actual Expenses
Actual %
Difference in $
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Chapter 6
Chapter 6
Financial Planning
Step 3. Prepare a Debt Reduction Plan. To effectively reduce
debt, you must follow certain guidelines. It’s that simple. First, set
attainable goals. As you learned earlier in the manual, goals provide a
roadmap for direction and clarity in times of uncertainty and confu
sion. Start with the goal setting form to begin the process. As you set
the date for eventual freedom from debt, you must be practical, yet
somewhat prescient since you don’t have control over every factor.
This should not discourage you from attempting a best estimate. The
final date for completion is perhaps the most critical, yet the most
difficult to establish. The underlying strategy is to free up income.
You no doubt understand the need for a budget and already have the
forms available to determine where you need to control costs. You also
need to know how much money is available for use in debt reduction.
With that knowledge in hand, you need to first pay off all past due
bills, particularly any back taxes. Clearly, these are the most pressing
debts because they impact your credit rating, which in turn limits your
ability to borrow in the future at a favorable rate of interest.
With those debts addressed, you need to establish an emergency
fund for those unforeseen, catastrophic problems that can occur at
any time. These funds should be enough to last for three months of
normal living expenses. The three-month rule is based on the time
frame under which most disability insurance policies go into effect.
You need to live during this uncovered 90-day period and have funds
available for quick use. The funds should be placed in a money
market account with check writing ability. The interest income gener
ated should be allowed to grow within the fund. Interest rates on
money market accounts are usually at a rate approximately equal to
inflation. This will keep the account stable over a long period. It also
is wise to maintain this account at a very large regional or national
bank with branches across a broad area or in a mutual fund. Why?
If a catastrophe hits a certain geographic area, the funds can still be
withdrawn. This might not be possible at a smaller community bank.
From day one of your debt reduction plan, consumer debt is paid off
immediately, or at the end of the month on your credit card state
ment. However, you already may have accrued some consumer debt
before your plan was in place. Now is the time to begin to pay it off.
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Financial Planning
There are two schools of thought here. One says to first pay off the
debt with the highest interest rate. Rationally speaking, this makes
the most sense. The second school of thought says to pay down the
debt from the smallest bill to the largest. This appeals to your emo
tional, irrational side, since you seem to make headway quickly and
the process feels less onerous. Both approaches have merit, so you
need to do some introspective thinking to determine which approach
is best for you and your personality.
Once you have paid off one debt, take the amount of that note and
use it to pay off the second note. As you pay the next debt off, repeat
the process again. This speeds the debt reduction process and can
provide a sense of satisfaction, as well as a bright light at the end of
that dark debt tunnel.
In the end, you will have a great deal of disposable income and the
only debt left will be good debt (home mortgage and practice debt).
Then you can prepare for retirement by contributing more to your
retirement plan.
Debt Reduction Outline
Set Financial Goals
Establish a Budget
Determine Available Dollars for Use
Pay Past Due Bills
Establish an Emergency Fund
% Month Net Income
Pay Off Consumer Debt
Retirement of Long-Term Debt
Qualified Retirement Plan
Savings
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Chapter 6
Chapter 6
Financial Planning
Insurance Overview When you purchase
insurance, you are not
buying a tangible product
like a hand piece. Rather,
you are buying a promise
from the company that
says it will be there when
you need it and that it
will arrive with financial
support to protect your
practice.
Many times, when the word “insurance” is mentioned to dentists,
their first thought goes to collecting fees owed to the practice from
dental health insurance providers. That’s one interpretation of the
word, but this section will focus on the types of insurance coverage
dentists need to protect themselves from a devastating financial loss.
Many insurance products fit this definition and, depending on the
arrangement of your practice, you may need to purchase some of
them, or even all of them at some point. In this section, we’ll try to
make it easier to understand what you might need, when you might
need it, and provide basic knowledge to help you make an educated
purchase. But first things first….
Insurance, at least according to Merriam-Webster’s Collegiate®
Dictionary, Eleventh Edition, is:
“Coverage by contract whereby one party undertakes to indemnify or
guarantee another against logs by a specificed contingency or peril.”
This means that you give somebody (the insurance company or
its agent) some money (premium) and, in return, they promise to
indemnify (pay) you or somebody else to whom you owe money,
because of a loss (as long as it’s covered by the policy).
And, as long as a lot of people are paying money to the insurance
company on a regular basis, the insurance company should have
enough money available to pay the people who have losses. This is
commonly referred to as the law of large numbers. The premiums of
the many fund the losses of the few. Basically, all types of insurance
work this way.
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Financial Planning
In the insurance industry, there are essentially two major branches:
Property & Casualty and Life & Health, with many sub-branches. For
a dentist/insurance consumer, it looks something like this:
Property & Casualty
Life & Health
Commercial Lines
Casualty
• Professional
Liability
• General Liability
• Employment
Practices
Liability
• Miscellaneous
Coverages
• Workers
Compensation
• Umbrella
Personal Lines
Property
• Fire Policy
• Business
Owners Policy
•
•
•
•
Homeowners
Automobile
Umbrella
Specialty
(e.g., boat, RV,
etc.)
•
•
•
•
Life
Health
Disability
Miscellaneous
Coverages
For your purposes, we will start on the left and work our way to
the right side of the above chart as we discuss the various types of
insurance available and the exposures they address.
First, regardless of the type of insurance product you are looking
to purchase, there are several basics to consider and the financial
condition of the insurance company is a primary concern.
When you purchase insurance, you are not buying a tangible product
like a hand piece. Rather, you are buying a promise from the com
pany that says it will be there when you need it and that it will arrive
with financial support to protect your practice. How can you be sure
the company you chose will live up to its end of the promise? The
answer is through some detective work, but there are companies out
there that do a lot of the sleuthing for you.
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Sources of insurance company evaluations include:
• Standard & Poor’s for company’s credit ratings
• Weiss Research for financial ratings on all types of financial institu
tions including insurance companies, banks, brokerage firms, etc.
• Duff & Phelps for financial ratings
• Moody’s Investor Services for credit ratings and risk analysis
• A. M. Best for a “financial size” rating and a “general
policyholders” rating.
When you get to the individual sites, look for letter-based ratings,
such as AAA, which means an insurance company is particularly
strong in terms of financial security, all the way through R, which
means a company has had a regulatory action regarding its solvency.
Such ratings are a quick and reliable way to at least narrow down
your choices and weed out those companies that are rated marginal
or worse. Your best option is making a short list of companies in
which you are interested, and running that list by your financial advi
sor to compare notes and get advice based on his or her experience.
Commercial Lines
Professional Liability
Professional liability, or malpractice, insurance is arguably the most
important coverage you can buy as a practicing dentist. While the
intent of this coverage is to indemnify (read: reimburse) your patients
for claims, it accomplishes much more. When properly structured,
this coverage can defend your professional reputation, safeguard your
livelihood, reassure your patients, and allow you to sleep better at
night.
Professional liability insurance is designed to pay money to a third
party (your patient or your patient’s family) as reparation for bodily
injury from something you did or failed to do. Generally, your patient
will claim that you failed to do as good a job as another dentist would
have under similar circumstances. Or that you failed to do a proce
dure another dentist under similar circumstances would have done.
A typical resolution is to provide the injured party with a settlement
amount that contemplates payment for the procedure you may have
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performed, future treatments, future materials (implants, bridges,
crowns, etc.), pain and suffering, lost wages, etc.
Your professional liability policy will pay this settlement and the cost
of a professional claims consultant who advises you at each step of
the process. If the claim becomes a lawsuit, you also will be provided
(at your insurer’s expense) an attorney who is an expert in the de
fense of malpractice suits. The three of you (you, your attorney, and
your claims consultant) will work together on a strategy to settle or
defend the claim.
The main goal should be preservation of your professional reputation
and to that end you will work with your defense team to negotiate a
strategic settlement or mount a successful defense against a claim of
malpractice. In the unlikely event of a judgment against you, the pay
ment made by your insurance carrier will safeguard your livelihood
and ensure the future viability of your practice. Your patients will
continue to view your practice as a successful business and you as a
reputable practitioner.
Claims-Made and Occurrence Policy Types
There are basically two types of professional liability policies: Claimsmade and Occurrence. The coverage is the same, but the response
time to the claim differs. Let’s look at a couple of timelines:
Assume an occurrence policy was purchased Jan. 1, 2000, and re
newed every year.
Occurrence
Policy purchased
1/1/2000
>>
Patient treated
3/1/2004
>>
Patient files claim
6/1/2006
The occurrence policy in force when the incident took place (in this
case the policy issued on Jan. 1, 2004) is the policy that responds to
this claim.
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Using the same set of circumstances, but assuming that a claimsmade policy was purchased on Jan. 1, 2000, and renewed every year:
Claims-made
Policy purchased
1/1/2000
>>
Patient treated
3/1/2004
>>
Patient files claim
6/1/2006
The claims-made policy that was in force when the claim was made (in
this case the policy issued on Jan. 1, 2006) is the policy that responds
to this claim.
The difference between the two policy types is largely the first few
policy years. If, upon graduation, you purchase a claims-made policy
type, you know that the response to claims made will be during the
policy period. Since it is highly unlikely you will have a claim made
against you in the same year you perform dental treatment (claims
typically take a while to develop), the insurance company requires a
lower premium to fund your exposure. Premium increases are often
referred to as claims-made steps, with four to six steps included in a
claims-made policy rating plan. The simply means that your premium
will start low and increase incrementally for the first four to six
years. Once the “top step” is reached, your policy will be considered
a mature claims-made policy. At this point, there is practically no cost
difference between the two policy types.
If you first purchase an occurrence type policy, that policy may be
invoked in response to a claim several years in the future. Insurance
companies, hedging against this unknown potential cost, will charge
two to three times more compared to a first-year claims-made policy.
The occurrence policy costs remain steady (excluding any company
rate changes) for the life of the policy.
So, the decision is simple, right? Buy the claims-made policy because
it’s cheaper. Somehow, you knew the decision would not be so easy.
Here’s why: The policy differences arise once again when you stop
practicing dentistry (due to retirement, disability, or death). Since a
claims-made policy must be in force constantly, you would have to
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renew it forever to maintain coverage for claims that occur after you
stop practicing. This is clearly impractical, so insurance companies
have developed “tail” coverage—a policy endorsement purchased
when you stop practicing dentistry to cover future claims. That tail
can cost up to three times the annual premium for professional li
ability, which offsets the discounted rates when the policy began. An
occurrence policy pre-funds this exposure during the first few years
of the policy when claims-made is cheaper.
Most major companies will provide tail coverage for free under cer
tain conditions (the most common being at least five years of cover
age and retirement). This provision for a free tail results in claimsmade being cheaper in the long run.
How much does it cost? Historically, professional liability insur
ance for dentists has been rated based on the use, and relative risk,
of anesthesia. When dentists used only local anesthesia, they were
considered Class 1 or Class A, the base class. Today, more and more
companies are refining their rating approach in response to advances
in dental practice by applying rates based on procedures performed
in the practice. A dentist’s professional liability premium, in other
words, will reflect only those procedures performed. A dentist who is
not performing high-risk procedures does not subsidize those who do.
Premium costs for an occurrence or mature claims-made policy vary
widely by state. The cost of a policy with typical limits of $1,000,000
per claim and $3,000,000 annual aggregate can range from about
$800 to about $4,500, resulting in a countrywide average of about
$2,000. Most dentists select $1,000,000/$3,000,000 limits, although
higher and lower limits are widely available. Typical rating rules also
provide for a variety of credits depending on the unique characteris
tics of each dentist. Some of these credits can include:
• Claim free
• Part-time
• Recent graduate
• Approved risk management classes
• Membership in organized dentistry
• Leave of absence
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Policy Provisions
Professional liability policies generally do not vary too much between
insurance companies. However, there are a couple of provisions of
which you need to be aware.
Consent to settle. Because your professional reputation is at stake in
any allegation of malpractice, many, but not all, professional liability
policies will contain a clause that leaves the option of settling a claim
up to you. Some companies will give you an indisputable right to re
fuse to settle. Others may penalize you if you don’t consent to settle,
because the ultimate resolution of the claim results in additional cost
to the insurance company. Still others may mandate arbitration or
mediation if consent is withheld. You need to understand the consent
provision of the policy you purchase and be sure you are comfortable
with the provisions.
Sexual misconduct. Many policies will exclude defense and indemnity
coverage for allegations of sexual misconduct made by your patients
(allegations of sexual misconduct made by your employees can be
covered by an Employment Practices Liability policy, discussed
below). This is despite the fact that patients under the influence of
nitrous oxide can and do have hallucinations. The best you can hope
for is a policy that will provide defense against such allegations, but if
you are found guilty of sexual misconduct you would be responsible
for any settlement.
Disciplinary defense. More and more state regulatory agencies are con
ducting investigations of dentists. Many, but not all, professional li
ability policies will contain a provision that will defend you if you are
called before your state license regulatory agency. You need to realize
that such hearings are legal proceedings and you need to do every
thing you can to properly represent yourself. A successful defense in
a state regulatory hearing can reduce the likelihood of a claim.
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Professional Liability at a Glance
• Covers your actions (or inactions) as a dentist
• Two policy types
* Occurrence
o “Tail” coverage pre-funded
Claims-made
*
o “Tail” coverage paid for (or maybe not) when you stop practicing
dentistry
• Innovative companies establish rates based on procedures performed
Credits are generally available
• Important policy provisions
Consent to settle
Sexual misconduct allegations
Disciplinary defense coverage
General Liability
Usually called “Slip and Fall” insurance, general liability coverage is
far more. Like all policies with the word “liability” in the title, this
coverage is designed to provide financial compensation to an injured
third party when that injury occurs on your premises (e.g., waiting
room, parking lot, restroom, etc.) or within your practice. A slip and
fall in the office is a very common general liability claim. However,
coverage also is provided for exposure, such as libel and slander,
emergency medical expenses (e.g., ambulance for person who falls),
assault, battery, invasion of the right of privacy, and more. Naturally,
this policy will exclude any professional liability-type exposures since
these are covered by your professional liability policy.
When do you need to purchase a general liability policy? You need to
make the purchase when you become an owner of a practice and you
sign a lease for an office. It is at that moment that you have created a
general liability exposure for yourself.
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How do I buy a general liability policy? General liability coverage for
a dental practice is not costly and is usually combined with other
policies for that reason. For example, most professional liability insur
ance also will include a general liability policy. Or, when you pur
chase property coverage for your practice, you can add the general
liability coverage.
Miscellaneous Liability Coverage
The following miscellaneous liability coverage are most often (for
dentists) combined with other policies. Many professional liability
insurers will “package” some or all of these coverage. Often the pack
aged coverage has a specific limit that may or may not be changeable.
Look closely at these coverages and the limits they provide. A pre
packaged solution may be perfect for your practice, or not.
Employment Practices Liability. This policy is a must-have for any
dentist with employees, because it provides coverage for allegations
of sexual harassment, discrimination, or wrongful termination made
by them. While this policy will certainly pay any claim settlement, it
also will pay to first defend you against such allegations.
Employment practices liability is different in that the cost of de
fending you against employee allegations is most often included in
the selected limit, so selecting an appropriate limit upfront is very
important.
Employee Benefits Liability. This policy is designed for practices in
which the dentist provides an employee benefit plan. It defends the
dentist (with defense in addition to any selected limit of coverage)
and indemnifies the employee. In general, if an employee alleges the
dentist has been negligent in the administration of plan benefits, this
policy will defend the dentist and pay any settlements. Typical claims
are the allegation that the dentist failed to enroll an employee in the
company health plan or interpreted the plan incorrectly or mis
handled plan records. Any one of these, or any combination thereof,
could result in a claim under this policy.
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Hired/Non-Owned Automobile Liability. To understand this coverage
consider the following: You ask your office manager to stop at the
bank at the end of the day to deposit the day’s receipts. Your office
manager, while driving her own car, is involved in an accident on her
way to the bank. The accident involves several people who are now
injured. When the injured people discover that your office manager
was running an errand for you, they file a claim against you for com
pensation.
Since the vehicle involved was not owned by the practice, this cover
age would apply. You would be defended (not subject to the policy
limits) and the coverage would pay any settlements or judgments.
This coverage does not include your employee’s injuries (the em
ployee’s own health insurance would cover this) or your employee’s
vehicle (the employee’s own auto insurance would cover this).
Umbrella Policies
In theory, an umbrella policy is designed to provide higher limits of li
ability coverage for any and all liability exposures you may have (um
brella policies only apply to liability insurance). In reality, umbrella
policies vary greatly. They are designed to provide higher limits (com
monly referred to as excess) for all the liability coverages you already
have (commonly referred to as the underlying limits). In general, they
are not designed to provide more coverage, only higher limits.
Umbrella policies are less regulated than other lines of insurance and,
as such, there are no standard provisions. Therefore, companies that
offer umbrella policies usually write their own policies, which in turn
reflect each company’s appetite for risk. You can never assume that a
given umbrella policy will provide all of the coverage you expect.
Many companies that offer umbrella policies will do so only if the
company that provides the underlying limits meets certain financial
requirements. This approach protects the umbrella insurer from
companies that could go under, which forces the umbrella carrier to
provide primary coverage. The prices charged by the umbrella car
rier, therefore, contemplate a solvent company providing the underly
ing limits.
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“It’s never too soon to start
planning for your financial
future. Saving even a small
amount each week can add
up with interest over time. It’s
hard to think of retirement
when you’re just beginning
your career, but life has a way
of speeding by. The sooner you
start to save and invest, the
sooner you’ll feel a sense of
financial freedom.”
Robert Margolin, DDS, FAGD
Scarsdale, N.Y.
Baltimore College of Dental
Surgery, 1988
Financial Planning
For example, as a dentist who owns a practice, you will purchase a
professional liability policy, a general liability policy, and an em
ployment practices liability policy. You select a liability limit of
$1,000,000 for each of these policies. You also have an automobile
that has been purchased by the practice. Your liability limit on the
business auto policy is $200,000. You then want to purchase an um
brella policy with a $2,000,000 excess liability limit.
The first thing you’ll find out is that your underlying automobile
policy limits are too low. You’ll need to increase the limits to at
least $1,000,000 or you will be responsible for the gap between the
$200,000 underlying limit on the business auto policy and the point
at which the umbrella limits kick in: $1,000,001. So, right off the bat,
you are potentially on the hook for $800,000. You need to realize,
too, that most umbrella insurers will not provide excess limits over
professional liability limits. And, only some will provide excess limits
over employment practices liability.
If you are looking to purchase excess limits provided by an umbrella
policy, be clear on:
• What is covered and what is excluded?
• Where are the potential gaps?
• Are my underlying limits sufficient?
• Are there specific requirements regarding my underlying coverage?
• What happens to my umbrella if I change the company that pro
vides the underlying limits?
Umbrella policies make sense for large business entities with many
types of liability exposures. They make less sense for a dental prac
tice. What does make sense for a dental practice is to take advantage
of the higher limits offered by the companies that provide your profes
sional liability and other policies.
A typical dentist will purchase a limit of $1,000,000 for professional
liability. On average, the premium for this limit will be about $2,000.
An additional $1,000,000 in limits (total of $2,000,000) would cost
about $300. An additional $4,000,000 in limits (total of $5,000,000)
would only cost about $700. It is usually much less expensive to
purchase higher limits on an existing policy compared to purchasing
a separate umbrella policy.
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Worker’s Compensation
Worker’s compensation coverage compensates employees who are
injured on the job. Most states have very specific laws governing
worker’s compensation coverage.
There are several states that do not allow worker’s compensation
coverage provided by insurance companies. Rather, the state provides
a similar benefit to employees. These states are:
• Nevada
• North Dakota
• Ohio
• Washington
• West Virginia
• Wyoming
Puerto Rico similarly provides a benefit to the employees there.
Worker’s compensation rates are based on the payroll of employees
participating in the coverage. Some states allow the dentist to partici
pate in the worker’s compensation program as an employee. In these
states, dentists do not have to declare at the inception of the policy
whether they are participating or not. If you are in a state that allows
the dentist to be covered, you should take advantage of this option.
Since the payroll affecting a worker’s compensation policy can
change during the course of an annual policy period, a worker’s
compensation policy is referred to as an auditable policy (i.e., the
policyholder receives an audit form at the end of the year in order
to verify the annual payroll). If there has been a significant change
in either direction (i.e., a significant number of people hired or fired
during the year), an adjustment will be make to the premium for the
expiring policy period.
Property Insurance
Probably the most straightforward of all commercial insurance for
a dental practice is property coverage—you own property, you buy
insurance for it, and if it’s damaged you get it fixed.
When discussing property insurance there are two types to consider:
• Real property (buildings)
• Business personal property (office contents)
Each of these are valued and insured separately. Generally, building
coverage is less expensive than business personal property (BPP)
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because fewer hazards apply to buildings (e.g., you can’t steal a
building).
A third type of coverage commonly included in a property insurance
policy is business interruption insurance, which provides for reim
bursement of lost business income due to a covered property loss. For
example, if you have a fire in your office and it will take about one
month to complete all of the repairs, that’s a month of lost income
that would be reimbursed under a business interruption policy. This
coverage is related only to covered property losses. It does not provide
coverage for lost income in the event you are ill and cannot work.
More than 20 years ago, the insurance industry began developing a
package policy for small business that would include property and li
ability coverages. Today these policies are typically known as Business
Owners Package (BOP) policies, and they are the norm for most dental
practices. A BOP policy combines all of your property, general liability
and business interruption into one policy, with one premium. Many
companies will have industry specific endorsements available (e.g.,
medical office endorsements) that provide some coverage unique to the
property found in a medical office (e.g., unique plumbing).
Property insurance is very much affected by the age, location,
construction, and condition of the property. In addition, property
insurance companies pay close attention to the value attached to the
property being insured. It is important to properly select the prop
erty limit of insurance equal to the full value of the property being
insured. Failure to do so can result in a financial penalty at the time
of a loss. Insurance companies develop property rates that take into
consideration:
• Available water supply to fight fires.
• Proximity to the coast and potential high winds in a hurricane.
• Fire department responsiveness (volunteer or paid).
• Frame construction (preferred) as opposed to brick in an earth
quake zone.
• Brick construction (preferred) as opposed to frame construction in
a fire zone.
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Personal Lines
The two traditional personal lines of insurance coverage are
homeowners and automobile insurance. There also are any number
of specialty coverages available for boats and other watercraft,
motorcycles, ATVs and other land vehicles, jewelry, furs, fine art, and
other valuables, and, finally, an umbrella under which they all sit.
Homeowners Insurance
If you own a home, your lender will likely insist that you purchase
homeowners insurance. But homeowners insurance is just as
important if you are currently renting an apartment. A homeowners
policy will provide you with coverage for your property—a building
if you have one, your TV, winter coats, kitchen table, etc. Even more
important is the liability coverage that comes with every homeowners
policy. If someone gets hurt while on your property (e.g., slips, falls,
and breaks a leg on the steps to your home/apartment), the liability
limits on your homeowners policy can reimburse them for their
damages, including the cost of defending yourself in a lawsuit.
But, keep in mind that not all homeowners insurance is the same.
Coverage comes in different varieties, which are typically designated
by the letters “HO” and then followed by a number: 1, 2, 3, and so
on. All of these products will provide coverage for the building, other
structures (e.g., detached garage), personal property, loss of use, and
personal liability (for injury to others).
If you own a condo or townhouse, similar forms are available (i.e.,
HO 4 and 6), but they don’t provide coverage for the building or
other structures.
HO-1: This form only covers 11 specific types of damage: vehicles,
smoke, vandalism, fire or lightning, explosion, riot, aircraft,
windstorm or hail, damage by glass/safety glass, theft, and volcanic
eruption. This HO version is expensive for the coverage you get.
It has been phased out in many states.
HO-2: You get all 11 coverages from the HO-1 plus 17 more. This
form is still used, but is not as good a deal as HO-3.
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HO-3: This form is the opposite of the first two. Rather than specify
ing what is covered, the HO-3 covers everything unless it is specifical
ly excluded. As you can imagine, this form of insurance costs more,
but it is worth the expense considering the breadth of coverage.
HO-4: This form is designed for apartment renters; coverage is simi
lar to an HO-3, but without building or other structures coverage.
HO-5: Available only for single-family homes, this is the most
comprehensive homeowners insurance policy. It includes extras
that would otherwise require the purchase of a separate policy (e.g.,
coverage for jewelry, art, antiques, etc.). It also can include coverage
for building code upgrades and sewer backups. Since this form of
coverage can cost as much as 15 to 20 percent more than an HO-3, a
detailed coverage comparison should be completed before a purchase
decision is made.
HO-6: This form is used for condominiums and some townhouses.
It is similar in coverage to an HO-3 and may provide some limited
coverage for the part(s) of the building for which you may be held
responsible (e.g., interior walls of a condo unit).
HO-8: This form is used for older buildings where the replacement
cost of the structure far exceeds the market value.
This summary of HO policy forms is very general and these provi
sions vary by state as well as by companies within states. Most home
owners policies have specific limitations on select, high-value items
such as jewelry and furs. Make sure your agent provides a detailed
explanation of the fine print.
Personal Automobile
Personal automobile insurance provides financial protection for you
in the event of an accident that causes bodily injury or property dam
age while you are driving. Personal automobile provisions and pricing
can vary widely. It would be wise to consult with an experienced in
surance professional in your state when you are looking for personal
automobile insurance.
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Like the homeowners policies described above, a personal automobile
policy is usually comprised of several major parts, including liability,
comprehensive, and collision.
Liability Coverage: If you, or any person using your “covered auto” are
responsible for an accident, the liability portion of the personal auto
mobile policy pays for bodily injury and property damage. State laws
usually mandate the minimum limits for this coverage and the cover
age itself is not optional. As a dentist, you should have a minimum
of $300,000 liability coverage. However, this should be considered a
minimum, with the policy preferably covering you for $1,000,000 or
even higher with a personal umbrella for any excess.
Comprehensive coverage: Sometimes called “accidental loss coverages,”
these provisions of the policy are designed to provide coverage for
your vehicle for specific perils specified in the policy. Typically, theft,
vandalism, fire, and broken glass are covered and often much more
depending upon the insurance company. Loss to your auto due to
collision is specifically excluded in this section.
Collision Coverage: This section of a personal automobile policy
provides collision coverage for your automobile. This policy applies
regardless of who is at fault and will be in force when the insured
cannot recover damages from another party because his personal
negligence was the cause of the accident or the driver of the other
auto has no insurance. The innocent driver collects the insurance
proceeds, less the deductible, and the insurance company collects
from the negligent driver.
Most policies also will contain additional coverages, such as:
Medical payments: This coverage provides financial support for
emergency medical treatment for anyone involved in a motor vehicle
accident. It will generally have specific limitations regarding who is
covered, the limits of coverage and the scope (e.g., emergency only)
of the coverage. Coverage also applies to the named insured and
family members if they, as pedestrians, are struck by a motor vehicle
designed for use on a public road.
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Uninsured motorist: This provision will protect you in the event that
you are struck by a driver who is not insured or is insufficiently
insured. It also can provide coverage for you in the event of a
hit-and-run. This coverage is usually written with a single limit for
all persons injured in a single accident. The standard limit is the
minimum required, but higher limits can be purchased. Excluded
from this are vehicles owned by or furnished for the regular use of
the named insured or family members. Also excluded are vehicles
designed for off-road use.
Other options: Towing, road-hazard, and windshield repair are among
the most common optional coverages that may be available under a
personal automobile policy.
Specialty Coverages
If you own even a moderate amount of high-valued jewelry, furs,
works of art, photography equipment, firearms, golf clubs, stamps,
coins or other collections, you may want to consider a specialty
policy often called a “floater.” This type of policy is generally avail
able from your homeowner’s insurance carrier and, in some cases,
can be added as an endorsement to your homeowner’s policy. This
specialty coverage provides higher limits than would normally be
available under a homeowner’s policy and may even cover your
property for a wider range of perils.
Boats, recreational vehicles, snow machines, Jet-Skis, and the like
all have very specific exposures and are not generally covered by
traditional homeowners or automobile policies. Generally, the dealers
or retailers who sell these products can provide you with information
regarding the appropriate coverage.
Disability Income Insurance
It’s the kind of thing no dentist wants or tends to think about,
especially a young dentist who is feeling relatively immortal. But
an injury or medical condition that puts you out of commission can
happen virtually any time, any place—and at any age.
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Veteran dentists have discovered from experience that dental clini
cians probably need disability insurance more than life insurance,
especially younger practitioners. Most dentists come into the profes
sion aware of standard neck and back injuries that come with the job,
but experience tells them that it’s the injuries you don’t expect, like
falls or car accidents, that happen suddenly and could sideline you
permanently. Often, the difference between such an injury being seri
ous and disastrous is disability insurance.
Still undecided because of the expense? Look at the statistics. Work
ers are almost two times as likely to be disabled than to die before
they retire. A 20-year-old has a 17 percent change of dying before
reaching retirement age, but that same worker has a 30 percent
chance of being disabled before he or she reaches retirement.
Beyond the numbers, you also need to realize that dentists occupy a
unique place in the health care field that comes with some unique
vulnerabilities. At the top of that list is probably the fact that most
dentists practice solo, with their livelihood depending on their ability
to produce. Similarly, dentists’ dependence on their hands and eyes
place them in danger of losing income should they injure or develop
chronic problems with either one.
Yes, disability insurance can dwarf life insurance in terms of cost, but
it could be an even more important investment. Dentists may be able
to rely on savings or on the payout of existing accounts, but it might
not outlast their disability. As a new dentist just beginning to build up
a patient roll and production, you are particularly vulnerable to that
happenstance, because you are far less likely to have the fall-back
resources of a dentist who’s been in practice 10, 20, or 30 years.
Under current tax laws, disability benefits are nontaxable. Experts
suggest, therefore, that dentists carry a policy equal to 60 percent
of their pretax income, minus overhead costs. This ensures that you
won’t see a significant drop in your net income when you receive
disability benefits. The experts also advise young dentists to buy dis
ability insurance as soon as possible, preferably flexible plans you can
add to over the years. Simply put, it’s a very important part of your
overall financial planning, so don’t overlook it.
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Look for a policy that comes from a clearly reputable company, in
cludes cost-of-living riders, and is not cancelable before age 65. Most
of all, read the fine print because many policies intended to protect
you may be riddled with exceptions and conditions that can keep
you from getting the benefits you need. Just as you would investigate
dental products before investing in them, so too should you pay close
attention to the provisions of your disability insurance.
Good advice is never
a waste of money,
especially when the
advice is about money.
One sound recommendation is to look for policies that cover den
tists on an “own occupation” basis, meaning you’ll receive disability
benefits if you are unable to perform the substantial material duties
of your profession, regardless of whether you’re a general dentist or a
specialist. Without an “own occupation” provision, a disabled dentist
may not be able to collect on his or her policy, if he could physically
work in another profession.
Policies also should encourage dentists to return to work, but you
should stay away from a policy that halts benefits once the dentist re
sumes practicing, even part-time. Another recommendation: coverage
that allows benefits for both partial and total disability.
And don’t forget temporary disabilities—those lasting from two to
three months to one year—which will require you to have a Business
Office Policy as well to help cover office overhead expenses like staff
wages, mortgage or rent payments, uniforms, and supplies. Many
policies also include the cost of hiring a replacement dentist to fill in
and keep the practice going.
Most importantly, be proactive and make certain your policies are
worded in a way that ensures the kind of coverage you may need.
Underwriting for disability insurance coverage is more exacting than
that for life insurance.
Policy tips
• Keep your old policy if you already have one. Don’t replace your
old plan; instead, supplement it with options. Over time, insur
ance companies restrict their benefits, and older policies may have
features and provisions that are unavailable today.
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• Overestimate: It’s better to have too much coverage than not
enough. Purchase a flexible plan that allows you to add coverage
later.
• Go early: Premiums increase as you get older, so capitalize on
lower costs while you’re still young.
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”One of the wisest decisions
any dentist can make is to
find a trusted accountant
and financial expert. Don’t
be afraid to interview more
• Update your policy: Any time your income or family responsibil
ity changes significantly, you should adjust your policy, adding or
subtracting coverage accordingly.
than one candidate and be
• Seek advice: An accountant, lawyer, or insurance agent you trust
can help you interpret the stipulations of your policy and keep you
informed of changes that need to be made.
clients?’ You need someone on
many dentists do you have as
your side who is knowledge
able, reliable, and accessible.“
Ralph A. Cooley, DDS, FAGD
Conroe, Texas
Retirement Planning
You may be saying to yourself, “C’mon, I haven’t even started to
practice yet and you want me to think about retirement?” Well, yes. It
seems awfully early to do so, but the earlier the better. It’s always to
your advantage to get going on a retirement savings program because
you’re giving it time to accrue—make you money. The later you start,
the less time there is for interest. And, in this case, more is definitely
better than less.
Although it’s unlikely that our Social Security benefits will end in
the foreseeable future, it’s even more unlikely that we could live
comfortably on the benefits provided. By law, the Social Security
Administration must send an annual accounting of your benefits
every year. This form will tell you what Social Security will pay for
both retirement and disability. If you are married, you’re entitled to
150 percent of the retirement benefit. For most dentists, this is in the
$30,000 range. Although you can rely on the Social Security benefit
(for now), it would be imprudent to believe it’s enough to live on
completely. So, you need a plan that will maintain a certain lifestyle
into retirement. Yet, the vast majority of dentists are unprepared for
the reality of retirement. Where do you start?
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Baylor College of Dentistry,
1980
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Financial Planning
First, we’re going to give you advice that you’ve gotten in many other
places of this manual: If you aren’t versed in retirement options and
where to put your savings, get a professional advisor. That could be
a certified public accountant, a certified financial planner, or an at
torney with experience in that field. Again, you may be reeling from
the debt you accumulated just getting through school, but the money
you spend now on the right advice will more than pay for itself in the
future. Good advice is never a waste of money, especially when the
advice is about money.
While there are many forms that retirement planning can take,
experts seem to largely agree that, for dentists, the biggest advantages
lie in tax-qualified plans, such as pension and profit sharing. Younger
dentists also have benefited from a supplemental individual retire
ment account (IRA), as have millions of Americans who employ these
easy-to-administer plans.
A tax-qualified retirement plan requires dentists to make contribu
tions for themselves and for full-time employees who qualify. If
you’re an associate right out of school, you’ll have to practice some
patience first. Employee dentists can’t employ a tax-qualified plan.
But, as was said earlier, you can certainly start moving down the road
to financial freedom with an IRA, which will accrue as you work
your way toward your own practice and a tax-qualified retirement
plan that benefits both you and your valued staff.
There are many types of IRAs, and at first glance, they all seem
similar, if not the same. But judging an IRA by its cover can be
dangerous. Look into the various types of IRAs offered and get advice
that will help you decide which best fits you.
Tax-qualified plans for a dentist/owner include 401(k) plans and
profit sharing plans, among other options. What qualified plans do,
basically, is two-pronged: They provide employees with welcome
benefits and act as tax shelters. This is to a dentist’s benefit, obvi
ously, because you are allowed a federal tax break in order to offset
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Financial Planning
the cost of offering a similar plan to your employees. It’s a win-win.
The profit-sharing plan is the most popular among dentists because
it builds in lots of flexibility. The business owner, for example,
can contribute and deduct between zero and 25 percent of eligible
participants’ compensation up to a maximum each year. In a given
year, you may decide to make no contribution at all, which may be
a good option depending on your income. Allocation also is flexible,
allowing three methods: the same percentage of compensation for
each participant, a permitted disparity (Social Security integration),
and age-weighted. Sole proprietorships, partnerships, limited liability
corporations, and incorporated businesses (including S corporations)
can offer profit sharing plans. The addition of a 401 (k) supplements
the profit-sharing plan by enabling dentists and their employees
to make more retirement plan contributions than what is allowed
by law under profit sharing plans. Be sure to look carefully at the
variations in 401(k) plans, which differ in the maximum contribution
you can make in a given year and in the contribution requirements
that apply to your employees.
In any case, take it slowly, consider your options, and proceed with
caution. Unscrupulous financial planners are a dime a dozen and
they prey on those who may not be completely up to speed on the
complex world of investment. If you know a seasoned, trusted dentist
who has a practice and a retirement plan that works well, ask him
or her for some informal continuing education on the topic. Get
referrals to respected plan administrators and to financial planners.
If you have access to a local study club, use that venue to broach the
subject with experienced study club members. And look to the AGD
for continuing education courses and seminars on the topic.
Remember the golden rule: Dentistry is a life-long learning experi
ence. And you are a business owner, as well as a clinician and health
care provider. Your patients were careful about who they chose to
restore and maintain their oral health; you need to be equally careful
about who you choose to help guide you toward a resource-rich
retirement.
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Who and what plan you choose can depend, at least in part, on
when you would like to retire. The usual age of retirement for the
American worker is age 62. Although a recent study indicated that
most people would like to work longer, health issues often intervene.
When it comes to new dentists, many want to retire between ages
50 and 55. Early retirement can certainly be accomplished, but it
requires plenty of forethought, dedication, and sacrifice.
Gathering Data
Let’s use the current median annual income for general dentists
($160,000) as a starting point. In a study on retirement income needs
at Georgia State University, the statistics show that most retirees live
on 70 to 75 percent of their pre-retirement income. This number can
vary from person to person, but let’s use 75 percent in our calcula
tions. The “average” dentist, then, will need 75 percent of $160,000
to maintain his or her current lifestyle. The figure for our retirement
fund thus becomes $120,000.
If you take early retirement (age 62), your Social Security benefits will
be reduced. If you wait until age 65, or age 66 in some cases, you will
receive full retirement benefits. Which benefit is best for you? Well,
if you need the money at age 62, you take the early benefits. If you
can afford, literally, to wait and are in good health, you can take the
benefits later. Since the break-even point is at age 80, it pays to wait.
However, if your health is suffering or there is a family history of
problems, then the best bet is to take the early money.
If you are married, and the majority of you will be, you will receive
a benefit no greater than 150 percent of your retirement benefit as a
spousal benefit. This, of course, depends on whether or not you are the
major bread winner in the family. Our “average” dentist, we’ll assume,
is married and she and her husband will receive an annual benefit
of $30,000. If they receive their benefit at age 62, it will be about 20
percent less, or $24,000 annually. We’re also assuming that she does
not need the money early and chooses to wait. So, our average dentist
needs enough money in her retirement fund to produce $90,000 annu
ally. This seems like an achievable number, but let’s look further.
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Financial Planning
There are relatively few older graduates out there; the majority of
dentists graduate at age 26 or so. For our example, let’s say the aver
age new dentist is age 26 and plans on a 36-year career, with retire
ment at age 62. Most financial planners will tell their clients that
due to the enormous improvements in health care and lifestyle, they
should expect to live until age 90. That’s a long retirement. There’s
an old adage that once a ship is in mothballs, it’s difficult to reacti
vate it. The moral is that you want to keep going and in our society,
that requires money.
Investments
Investment returns vary greatly. For example, over an 80-year period
stocks have provided an annual 10 percent return, while bonds have
delivered 5 percent returns, money markets 4 percent, and inflation
4 percent. However, if you invest your money at the wrong time, say
right before the 1929 stock market crash, you could be broke. It’s
imperative, then, that you diversify your funds among the differ
ent asset classes. Let’s assume you’ll receive an 8 percent return on
investment funds. This is a conservative and manageable.
Even when you get a reputable financial or retirement planner in
volved, you will do yourself a big favor if you learn some of the ropes
before you sit down with him or her. If you decide to do retirement
planning yourself, you are going to need to know more than the basics.
A good place to start is the Internet, where you can find several Web
sites sponsored by mutual funds that allow you to calculate your
retirement income needs. Some over-estimate your retirement needs,
others under-estimate. Again, each of your individual specifics will
vary; we’re simply providing the basic information that the average
dentist needs when young to see the ramifications involved in retire
ment planning.
Most financial planners agree that retirees should not take more than
4 percent out of retirement funds on an annual basis. The Social
Security component will receive cost of living increases annually,
but our $90,000 remainder will not. Actually the math is simple—if
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you multiply $90,000 times 25 (100 percent/4 percent), you get
$2,250,000. That’s how much the average dentist must accumulate to
reach her goal of retiring at age 62. If he or she has no money saved
to this point, then he or she must save $12,025 annually at 8 percent
to reach that figure. If the dentist and his or her spouse wait until age
40 to begin, the amount becomes $40,572. Clearly, the difference is
staggering.
Using time and compounding interest to our advantage are two of the
key elements to successful retirement planning, but it’s essential you
start now. Although you may not be able to save $12,000 toward your
retirement as soon as you get out of school due to debts and start-up
costs, any amount that you contribute will lessen the blow later when
you can save more.
Getting “There”
To save in a tax-deferred or tax-free environment you need to use
some type of formal vehicle recognized by the government. This
can run from the Individual Retirement Account, which is simple in
design and concept, to the very complex and costly Defined Benefit
Plan alluded to earlier. Since the concept here is to keep it simple, for
now let’s focus on the Roth IRA and regular IRA. Although there are
limits of $5,000 annually per participant, if a young dentist and his
or her spouse both contribute $5,000, together they come close to the
magical $12,000 figure. It could be a difficult figure to reach early on
in your career, but it is achievable.
A Roth IRA differs from a regular IRA in that you are taxed on the
money invested in a Roth IRA, but that money also is allowed to grow
tax-free. Any distributions also will be tax-free. The regular IRA allows
tax-free investment and it grows in a tax-deferred environment, but
when funds are removed, taxes must be paid. So which is best?
Typically, if you have a timeframe of more than 20 years to save, then
it’s the Roth IRA.
To participate in a Roth or regular IRA, you have income requirements.
Your financial advisor can help you understand those and remain up to
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Financial Planning
date because they are subject to change. Once you exceed the income
requirements you’ll have to stop making new contributions, but the
funds already there can still grow over time, so start one now in any
event. When you’ve reached this income milestone and can no longer
contribute to your IRA, that’s a good time to reassess your situation
with a financial advisor to decide where you should head next.
Most individuals and dentists today use mutual funds to accomplish
their remaining financial goals. One of the easiest and most success
ful investments today is an index fund at set intervals (dollar cost
averaging). This is a basket of individual stocks placed into a vehicle
called a mutual fund. This allows you, to purchase a part of every
company in the fund every time you make an investment in the
mutual fund. And this basket of stocks can replicate certain segments
of the economy. The most common index fund is the one that mim
ics the Standard & Poor’s 500, which is comprised of the 500 largest
companies in the country. These companies reflect long-term stabil
ity on investment. Although all stocks do decrease in value at times,
these stocks have consistently risen 10 percent yearly.
This technique, due to its low cost, will beat most professional inves
tors over a long time frame. If you’re looking into such a fund, start
with the Vanguard Fund. They have index funds to match the various
components of the stock market and bond market and can provide
money market accounts. However, there certainly are other funds
and fund families that can be used if you prefer. Basically, you want
to ask for an IRA application. You fill out the form and send in the
check. It’s that simple! These funds provide automatic debiting of
your account at set intervals, which makes it easy to do dollar cost
averaging. You buy more shares of a fund when the cost dips and
fewer shares when it is more expensive, which let’s you ride out the
bumps in the investment cycle. Over the long-term, dollar cost invest
ing should yield superior results for you.
Although this is indeed a relatively easy approach to meeting your re
tirement goals, you still can’t get complacent, meaning that you must
monitor the plan. In the movies, you get rich all of a sudden when
someone finds an ancient investment by Uncle Joe that is now worth
millions of dollars. That’s in reel life. In real life, you have to stay on
top of your investment to anticipate problems that may develop. One
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big advantage of the index mutual funds is that you only have to keep
your eye on the big picture (i.e., economic market changes).
After all that, here’s the take away message: Start planning for your
retirement now. The sooner you start saving, the easier it is to reach
your goal. Yes, you will be dealing with many expenses, and perhaps
significant educational debt when you start practicing, so the Roth
IRA may be your best bet early on. Since you and your spouse can
each contribute up to $5,000 annually, you’re on your way without
breaking your budget. Later on, look at those other plans we dis
cussed as a way to reach your ultimate goal.
Estate Planning
Much like retirement planning, estate planning can never be done
too early in your career. It’s another one of those potential contingen
cies that you must plan for in order to have your overall business
and practice plan functioning smoothly toward the eventual finish
line. Thirty years down the road is not the time to start concerning
yourself with retirement and estate planning, even though that may
be when life’s foibles finally begin reminding you directly that you
need to have these plans in place. It is better to do it now while you
are in a position to put in the time needed to get good advice and find
reputable professional consultants.
A short definition of an “estate” is all the property, real and personal,
owned by you prior to distribution through a trust or will. The list of
personal property is long by the time it needs to be disbursed and can
include cars, all manner of housewares, and bank accounts. Estate
planning, of course, is the way you make sure that all of that “stuff”
you’ve accumulated over a long and successful life gets to those you
specifically choose (heirs, close personal friends, institutions, etc.).
Proper estate planning also ensures that what your designees receive
is the maximum amount of your estate possible, so any estate planner
you choose had better be well-versed in federal and state tax law.
Estate planning is an ongoing process that requires constant monitor
ing. The reason: Your estate is constantly changing and so are the
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Chapter 6
tax laws that govern it. An example: The Economic Growth and Tax
Relief Reconciliation Act of 2001 gradually phases out the estate tax
through 2010. Each year the amount of the estate that will not be
taxed grows. In 2010, when the legislation expires, you may not have
taxes to pay, but in 2011 you will be back where you started, unless
Congress extends the act. Doesn’t make much sense, does it?
Conserving your assets as they build up over time is of utmost im
portance. Taxes, inflation, prolonged illness, and other expenses can
cause your estate to shrink. Planning for these contingencies can be
the difference in whether or not you meet your objectives.
As a graduating dentist, your first objective should be to build your
assets so that you actually have an estate to disburse. As is the case
for a sound retirement plan, you need to establish and follow an es
tate plan diligently. At this point it’s simple: Have a will drawn up by
an attorney. You do not need any complicated plans right now, but a
will is essential. Just having a will in place will give you a head start
on most dentists.
Just remember that your
will is not timeless. It
will need to be reviewed
regularly with your
financial planner to
ensure that it still applies
A will provides numerous advantages:
• It can minimize taxes.
• You can name a guardian for your children.
• You can make sure that your assets will be handled appropriately at your death.
• It provides provisions for you family’s protection.
• It allows you to name an executor to handle your wishes.
• It avoids delays and costs associated with intestacy (probate) court proceedings.
Just remember that your will is not timeless. It will need to be
reviewed regularly with your financial planner to ensure that it still
applies to your needs. You will always have the ability to change it,
and your attorney can advise you on when it’s time to do more.
Wills and trusts are the common ways that individuals disperse their
wealth, but they might not be enough to avoid probate state-to-state
and over time. There are many different estate planning tools based
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to your needs.
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Financial Planning
on meeting specific goals and common sense guidelines that make
sure your plan is iron clad, in a court of law or otherwise. Since this
can be a complicated area of law, the best advice is to seek the advice
of an attorney and/or certified financial planner for the distribution
of assets related to your practice or if you want the business orga
nization/practice to continue after you’re gone. If you don’t have an
adequate estate plan in place, your family could be put in a difficult
situation regarding your estate and assets.
Right now, it’s short and sweet. Get a will drawn up by your attor
ney to preserve those advantages referred to above. Don’t get caught
without one, because in reality you truly never know what will hap
pen tomorrow or the next day. That’s life. Later on, you can add to
the will based on advice from your trusted advisors, particularly your
attorney.
The National Association of Financial & Estate Planning
www.nafep.com
This privately held, for-profit organization based in Salt Lake City has a member
ship base that includes attorneys, CPAs, and financial planners nationwide.
NAFEP’s Web site features a lengthy section about estate planning with informa
tion and advice about general estate planning concerns, such as “Problems
Due to Incapacitation“ and “Death Taxes on Your Estate.” The site also has
a “Consumer Request for Contact” tool to help users connect with NAFEP’s
member professionals.
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Financial Planning
Tips on Taxes
Often, two heads are better than one. The world gave us Abbott and Costello,
Rodgers and Hammerstein, and Siegfried and Roy. Better together than apart,
these individuals discovered synergy. It’s no different in dentistry, and we have
Melvin K. Pierson, DDS, FAGD, and Norman E. Barnum IV as proof.
“It’s not so much taxes as business management,” says Barnum, a financial
management consultant in Philadelphia who counts Dr. Pierson among his many
dental clients. “I’m the CFO of his practice. That’s how I operate for most of my
clients. A lot of what I address is the concentration of cash flow and keeping
things running smoothly.”
Dr. Pierson says that Barnum told him you don’t get a good tax return unless
you plan for a good tax return. He says, “My accountant is in the speed dial on
my phone and, if I’m considering buying something, I call him. Dentists buy lots
of gadgets, lots of frivolous things, and see them as a tax write-off for one year,
but do these things really help production? Most dentists don’t look at these
purchases as investments.”
For example, last year Dr. Pierson had to choose between buying a digital radiog
raphy system or a laser used to diagnose caries. Among his considerations was
that the radiography system would certainly wow his patients when the high
resolution image popped up on a big screen. He also realized, in consultation with
Barnum, that his actual production would be about the same with conventional
X-rays and the few minutes it takes to develop the film. So, for a $20,000 invest
ment, he didn’t see much return, even with a larger one-time tax write-off.
Dr. Pierson and Barnum decided that the laser would help detect incipient caries
much sooner than would conventional X-rays, so by making a $5,000 investment
he was opening the door to production stemming from these caries, preventing
their growth, and making his patients happier. It was a win-win investment.
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Financial Planning
“The trick of the trade is to plan,” Dr. Pierson says. “Around October, start to
get the information together for taxes. I’m calling Barnum throughout the year,
telling him about plans to do this or that, asking him how it will affect production.
An accountant well-versed in dental services who can find you more deductions
based on knowledge and experience and certain purchases made at the right time
of year is a plus. Dentists are taught in school that they must have a treatment
plan, and if they see 20 patients a day, each has an individual plan. But when it
comes to purchases, they shoot from the hip as much as anybody.”
Dr. Pierson willingly shares another secret: “My office manager gives me a busi
ness, but nonclinical, perspective,” he says. “My accountant gives me the financial
aspect. My wife doesn’t know clerical versus clinical but has a gut feeling. And
through that process, there’s a consensus reached.”
Barnum’s first step with a new dental client involves taking a thorough inventory
of the practice. He looks to isolate and determine where the profit is made and
what the best avenues are for growth. “I see a lot of tax strategy that involves
finding the loopholes for a dentist,” he says. “It’s more about being attuned to
making a practice grow and what the impact of growth is on the practice. When
you do it right, it’s a matter of deferring income. If you are making a lot of money,
you don’t tend to worry about paying taxes.”
The previous was originally printed in AGD Impact, April 2006.
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Chapter 7
Networking
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Chapter 7
Networking
Moving Beyond the
Friendly Confines
If you are one of the
many dentists out there
who is simply interested
in furthering your
profession, professional
organizations are the
places where that
happens.
Unless you are planning to enter a residency program or specialty
training right from graduation, school is out—forever. While the
friends and mentors you cultivated during your training will still be
available, they almost certainly will not be located under one roof
and your close encounters with them will be far more challenging to
schedule. More reliable for a successful work life—and life in gen
eral for that matter—is the somewhat daunting development of new
networks, which can start out as feeling unfamiliar and uncomfort
able. But, before you begin fretting that you’re no social butterfly, you
need to realize that people are not born with that gift of gab. Sure,
some people seem outgoing from the time they are born, yet no one
networks in a professional sense without planning and careful consid
eration. Until now, you’ve essentially had your network created for
you. Now it’s time to move on.
Simply put, yet not as simply done, it’s very important for you to
constantly expand your network of colleagues and friends or at least
to make that as much a priority in your new practice as your hand
piece. Networking professionals generally recommend that you jump
right in and get used to the water. The longer you wait, the harder
the thought of the shock gets. That means letting everyone you can
think of in on your plans. You’ll be surprised at the number of people
you know who want—and are gratified—to help you get going. And
don’t be presumptuous. It’s difficult, if not impossible, to know
exactly where the best advice will materialize. It could be someone
with 35 years of experience in your profession, or it could be some
one who has nothing to do with dentistry but possesses a high level
of common sense.
Getting involved with people you don’t know is certainly hard but
can be extremely rewarding. That’s where organizations of all kinds
come into the picture, social or otherwise. You can be the most selfmotivated person in the world and you will still need someone, some
times, to listen, act as a sounding board, and keep your world from
becoming too insular.
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Networking
Finally, think of your networking life as a marathon rather than a
sprint. Don’t start in with new people by asking them for something.
Just make contact, try to get to know them through shared interests,
and file them in your Rolodex™. Networking isn’t about asking for
favors, but rather about putting yourself in a position to take advan
tages of opportunities that your network might present. Some people
call that luck, but by any other name, it still comes down to being in
the right place at the right time.
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“The end of dental school and
the licensure process signals
the abrupt end of guided
learning and the beginning of
self-directed lifelong learning.
I have had incredible support
Here’s a short fable to illustrate the above points: A young man in his
20s, according to a story in the Wall Street Journal (July 2006), found
most of his friends, and his career, through his interest in brewing
beer. He worked full-time as a carpenter but wrote articles about beer
after founding a home brewing club. He met his two closest friends
through that club and now writes enough to cut down on his carpen
try hours. He’s also writing a book and traveling the world to meet
other craft brewers. He has met all sorts of people who are passionate
about craft brewing, and they all want to help one another. So, as you
see, your interests in life, even beyond dentistry, can bring you into
contact with many friends and acquaintances.
The Main Roads to New People
In dentistry, as in many professions, there are four main roads to
travel when trying to network and expand your world:
•
•
•
•
mentors
study clubs
professional associations
other organizations
Mentors
You probably have a good handle on what a mentor is and what a
mentor does. The collegiate environment from which you are emerg
ing is built on a system of mentors who can advise you based on their
experience. Some students can claim mentors as friends; some men
tors fill that role for decades. The norm, however, is that the mentors
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from mentors and, in turn,
have always been happy to be
a mentor. The resources are
there. Use them.”
Bill Wathen, DMD
Dallas, Texas
University of Kentucky
College of Dentistry, 1967
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Chapter 7
Networking
you cultivated in school are going to be spending the bulk of their
time mentoring a new crop of future dentists. If you can maintain
mentoring relationships that evolved during your time in school, by
all means, make the effort to stay in touch.
“I can’t stress enough the
benefits of being active in
community organizations
outside of your practice. In
addition to the benefits you
receive, you also get to benefit
your community. It gives you
a healthy perspective on life
outside of the profession.”
David A. Tecosky, DMD, MAGD
Philadelphia, Pa.
University of Pennsylvania
School of Dental Medicine,
1979
As an associate in your first practice, you are very likely going to need
a new mentor. When considering your first place of employment, the
potential for advice and support is a factor to think about, especially
when the more technical aspects of the job are equal. Is the senior
doctor willing to provide clinical and business mentorship? Will he or
she be available for discussing treatment plans, and clinical proce
dures, and providing entrepreneurial training in managing a practice?
Any mentorship should be a give-and-take relationship. Will you also
guide the senior doctor on new methods and techniques learned in
dental school? Will you be allowed to do so?
While it’s a good idea to cultivate a mentor who also is a dentist,
preferably an open-minded and experienced one, don’t limit yourself.
A good mentor can provide valuable clinical support; he or she also
can provide moral support, practice philosophy, common sense, and
a professional context that is not limited to the practice of dentistry.
And, whomever your mentor, or mentors, turns out to be, make sure
that you bring something of value to the table as well. Mentoring
is not a static experience in which the mentor speaks and you take
notes. Its dynamism is what determines its value, so participate fully.
Study Clubs
It’s been said that the father of modern dentistry, G.V. Black, himself,
was asked to mentor a study club more than 100 years ago. Obvious
ly, dental study clubs have been around for a long time. Study clubs
among dentists stem in part from a historical fact: Most dentists have
practiced and continue to practice solo.
There are more associateships than in the past, partly because put
ting out a shingle right after school is a bit more complicated today.
And, of course, associateships can provide a learning environment
second to none. Or not. Getting into the right associateship can mean
mentors and sound clinical advice. It also can mean working your
tail off while covering for the senior dentist for two weeks while he
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Networking
sends postcards from the Bahamas. A more controlled and positive
learning experience can take shape in a study club composed of your
peers—senior or junior.
Chapter 7
23
“Check with specialists in your
area; they usually run study
Because so many dentists practice solo, or in very small group
practices, membership in a study club can provide professional inter
action and camaraderie that may not otherwise be available. Dentists
in study clubs most often talk about certain advantages, including:
increased clinical knowledge and skills; friendships with other
colleagues outside the operatory; development of a valuable circle of
professionals for referrals, as well as coverage during vacation time;
a regular chance to do some productive thinking outside the hectic
atmosphere of the practice; and the ability to get information on new
products from someone other than a company salesperson who may
or may not be giving you the whole picture.
clubs, which can be a good
In a study club, you learn in a creative environment that encourages
new ideas and discussion. Some study clubs are devoted to one topic
(e.g., cosmetics, pediatric dentistry, practice management), while oth
ers may broaden their scope to take in the daily challenges of dental
practice and whatever topic that might come to the table.
New Jersey Dental School,
1979
Being relatively young, you may feel that study clubs are an
anachronism of dentistry’s past, and statistics suggest that many
young dentists do not seek them out. This is a tragic mistake. A
good study club is not a kaffeeklatsch, although veterans of study
clubs recommend there always be a designated time for socializing
within a meeting. Rather, the best study clubs are generally the most
long-lived, and those are usually characterized by strong leadership,
mandatory attendance, an attendance fee regardless of attendance,
and due diligence in finding the best speakers independent of the
cost. A good study club always keeps the subject matter up-to-date.
Use these general parameters as a guidepost in choosing a study
club, or in starting one if your local area is without one. The point
is, well-run study clubs are worth their weight in gold, but they take
work and commitment from everyone involved. If you’re motivated
to improve your clinical and nonclinical skills, look for a study club
in your area and contribute.
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place to start networking. Also,
check with your suppliers, like
Benco or Henry Schein, for
clubs. Lastly, check academies
for study clubs specific to your
area of interest.”
Wesley Blakeslee, DMD, FAGD
Wall, N.J.
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Networking
Professional Associations
“The goal of your continuing
dental education journey
must be knowledge plus
integrity, and not only of facts
but also of values.”
Roger D. Winland, DDS, MS,
MAGD
Athens, Ohio
AGD Editor, 1996 –
The Ohio State University
College of Dentistry, 1970
This may seem self-serving, given this manual’s origin, but let’s use
the Academy of General Dentistry (AGD) as an example of why it
behooves young dentists to join professional organizations. For more
than 40 years, general dentists in the United States and Canada
have looked to the AGD for practical help in meeting their goals for
professional growth and practice success. This is no idle claim; the
AGD has become synonymous with continuing education over the
years. It’s the only organization that devotes 100 percent of its time
and effort to the issues faced by general dentists. Of course, we want
you to join if you’re going into general practice, but the real point
is that professional dental organizations are part of your world. We
won’t go into all of the benefits here, but these benefits add greatly to
the benefit of belonging.
Joining an organization is about taking advantage of a wide range of
resources, many of them human and communicative, which can help
you stay on top of a constantly evolving profession. The first rule in
dentistry is to never stop learning. As soon as you graduate, you are
going to be inundated with all sorts of offers for services, materials,
and equipment. A professional organization follows the trends
on these topics and many others as part of its everyday purpose.
Membership, therefore, can save you time and frustration because
these organizations provide information you won’t get anywhere
else. If you are one of the many dentists who is simply interested in
furthering your profession, professional organizations are the places
where that happens. So before you get too cynical about joining a
professional organization in the 21st century, carefully consider all
the benefits you can reap.
Here’s another good reason: “No one can know for certain what the
future of dentistry will hold. I think we will see an integration of
dentistry into comprehensive health care and an increased focus on
the link between oral health and overall health as we enter the 21st
century. Computer-assisted technology for diagnosis and treatment,
gene-mediated therapeutics, which alters the genetic structure of
teeth to make them impervious to decay, will also be important in
the future,” says Eric Curtis, DDS, renowned dental historian and
spokesperson for the AGD.
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Networking
Dr. Curtis also might well have paraphrased an old saying: “Learn
your history or you are doomed to repeat it.” Professional organiza
tions are an uninterrupted continuum of information from the past
and into the future. As a new dentist, you should immediately join
two organizations. One is the American Dental Association. This is
the organization that represents the interests of all dentists—both
specialists and generalists alike. The other organization should be
one that represents your particular interests. If you are a specialist,
that would be the group that represents your specialty. If you are a
generalist, that would be the AGD. If there are any other groups or
organizations that interest you, then join them and reap the benefits
of professional give-and-take.
Chapter 7
2
“The AGD represents “A Great
Dentist” to the public and to
our profession. I believe my
AGD membership makes me a
savvy dentist, businessperson,
caretaker, artist, scientist, and
legislator for our profession.
Through the AGD, I have
gained connections in the
dental industry with other
dentists, suppliers, educators,
Other Organizations
clinicians, researchers, and
Rotary International, Lions Club International, the Knights of
Columbus, the U.S. Jaycees…the list of “other” organizations is
probably long enough to straddle the equator completely around the
globe. Participation and learning are valuable for their own sake. For
starters, they teach discipline and communication skills, they provide
an important sense of place in your life, they introduce you to new
people who could become good friends, and they keep that gray mat
ter in shape. Practically speaking, they are conduits for education on
the prevention of oral disease and oral hygiene, and they are a way to
bring some understanding of your profession to those outside it. They
are sources of information that could come in handy when you least
suspect it, and they help you get out of your solo practice for some
fresh air. And, of course, they are a source of new patients, referrals,
and word-of-mouth compliments. Mostly, they help keep you from
stagnating, which normally happens long before you actually realize
it. People are ultimately social creatures—some of us are very quiet,
some are shy, some of us are so garrulous that everyone knows when
we’re coming, some are analytical, some are off-the-cuff creative, but
all of us have a need to share life and experience with somebody else.
Other organizations can teach you humility, because you are outside
the relatively comfortable world of dentistry.
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legislators. The AGD is the only
organization that exclusively
represents general dentists. To
reap the benefits that the AGD
has to offer, join and remain
an active member throughout
your professional life. Be A
Great Dentist!”
Laura Murcko, DMD
Highlands Ranch, Colo.
University of Pittsburgh School
of Dental Medicine, 1989
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Chapter 7
“Networking through the AGD
has allowed me to stand on
the shoulders of great leaders
from around the country.
Looking through their lens
of experience, I am able to
provide a broader range of
quality care to my patients.”
Kenton A. Ross, DMD, FAGD
Fayetteville, Ark.
ASDA National President,
1994-1995
University of Louisville, 1995,
University of Tennessee, 1996
Networking
There’s a saying that as soon as you think you’re being humble,
you’re no longer humble, so join other organizations to get outside
of tyourself. It makes you a more rounded person and, indirectly, a
better dentist.
It is very difficult to be a dentist and be an island unto yourself. Sole
proprietors are especially susceptible to isolation, due to the way that
they operate their practices. Interaction with others is important,
not only from a business aspect but also a personal aspect. From a
dental perspective, by involving yourself with other dentists, you can
provide a ready source of knowledge when questions persist about a
procedure. Sharing pearls of knowledge is important to improving the
care that your patients, as well as the patients of others, will receive.
Emergency care for patients while you are unavailable is a critical
part of a dentist’s life. Dental colleagues can provide this type of
coverage.
Networking exists in many forms—mentors, professional associations,
study clubs, and organizations outside of dentistry. By utilizing these
groups, you will not only grow as a dentist but improve your quality
of life. It is important to jump in quickly with these groups because
the longer you wait, the more difficult and uncomfortable you may
be in joining.
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Chapter 8
Continuing
Education
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Chapter 8
Continuing Education
Our Middle Name
If there is one thing about the Academy of General Dentistry (AGD)
that you should know, it’s probably the fact that the organization was
built on the concept of continuing education. The core competency
statement of the AGD is “quality of care through lifelong learning.”
The AGD was founded in 1952, a notable year in that it roughly
marks the beginning of dentistry’s 20th century revolution. Fiftyfive years later, mind-boggling progress in dentistry and oral health
has been accomplished. Some of the changes that have had a posi
tive impact on dentistry include increased emphasis on personal
hygiene, widespread availability of antibiotics, vaccines, fluoridation,
improved diets, esthetics, computers, and the Internet. The AGD and
all of organized dentistry have hustled over that time to keep up with
developments in oral disease prevention, treatment techniques, mate
rials, and other issues that impact dentists and their patients.
An increase in those over age 65 who still have their teeth has greatly
impacted dentistry, with more attention being given to the complex
needs of this older population. A more knowledgeable and affluent
U.S. population has proportionately increased dental visits for an
improved smile, in sharp contrast to the reasons for dental visits 50
years ago (i.e., to alleviate pain and restore function). This consumer
trend will only grow in the 21st century as more people retain their
healthy teeth for a lifetime.
When you graduate from dental school, you are prepared to practice
dentistry at that certain point in time at a certain skill level. As fast
as developments in the profession are moving, your skills will need
constant updating, thus the AGD’s emphasis on “lifelong learning.”
This isn’t just a catchphrase that sounds good on a Web site page. It’s
a necessity, especially in the 21st century. A sea of change in dentist
ry is about to occur and, consequently, you need to be on board the
ship. Continuing education is how you avoid being left behind once
school is out.
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Chapter 8
2
State Licensing Requirements
Before you get into the more altruistic reasons for continuing educa
tion throughout your career, consider the most practical reason of
them all. If you don’t satisfy a certain level of continuing education
requirements, usually expressed in hours, you will jeopardize your
ability to practice. It’s that simple.
While exact requirements vary from state to state, virtually all
require by law a minimum number of continuing education hours
in order to maintain your dental license. The range of continuing
education credit hours that dentists must have can vary from 15 to
100, with the cycle length varying from one to three years.
Many states also mandate continuing education on specific subjects,
such as AIDS/HIV, infection control, child abuse identification and
reporting, domestic violence, oral health effects of tobacco, and eth
ics. How continuing education credit is monitored varies from state
to state, from random audits to form-based annual reports. Virtually
anywhere you decide to practice, you will be required to fulfill
certain continuing education obligations. It is your responsibility to
fully understand your state’s requirements. These are usually well
spelled out in that particular state’s dental practice act.
Body of Knowledge
more from my fellow members
during the lunch break sitting
around the lunch table than I
did from the seminar itself. I
have gotten invaluable advice,
hints, and support from my
professional colleagues during
these breaks.”
Maharukh E. Kravich, DDS, FAGD Chicago, Ill.
University of Illinois at Chicago College of Dentistry, 1984
Put simply, it’s expanding every day—the body of knowledge, that
is. Look at it this way: How many new developments in techniques,
materials, and disease prevention and control came about just during
your time in school? If you’re thinking “not many,” then it’s time to
wake up! If you’re thinking “a lot,” then you realize how important
continuing education is to staying on top of your profession in clinical
and nonclinical ways. Just a few new developments can have you
grasping for more knowledge in order to maintain a 21st century
dental practice:
Technology. CAD-CAM, intraoral cameras, implants, salivary testing,
ergonomics, digital imaging, the Internet, advanced diagnostics,
lasers, sterilization…we could go on and on, but you get the point.
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30
Chapter 8
The fact that new dental technology arrives on the market almost
every day is not new. But there’s a big difference between being a
gizmo collector and choosing new technology that suits your practice
and adds to the desired result—optimal care for your patients. New
technology and materials are often introduced to dentists by
salespeople or other manufacturer’s representatives. While this is not
inherently bad, since it does allow an avenue for product introduc
tion, this introduction is motivated by an ulterior profit motive by
the salespeople. That’s how business works. Your ability to filter
fact from fiction and choose technology that improves your practice
depends on the body of knowledge that you have to work with.
The point is, when you
graduate from dental
school, you are prepared
to practice dentistry at
that certain point in time
at a certain skill level.
Disease paradigm. For most of the 20th century, oral disease was
met with a largely mechanistic approach to treatment. Someone, at
some point, codified that approach as “drill, fill, and bill.” All dentists
have heard the saying, and you may chafe at the characterization, but
as in any stereotype, there’s an element of truth within. Now, at the
dawn of a new century, the paradigm is shifting from treating disease
toward maintaining health. Part of that paradigm is that the mouth
is part of the rest of the body, and new evidence to that effect is
published every month. Already, researchers know that inflammatory
substances released by disabled oral tissue into the bloodstream may
lead to cardiovascular disease, diabetes, even the risk for pre-term
births. As a recent graduate, you are going to spend most of your
career as a “physician of the mouth,” who has more interaction with
the other health professions than ever before.
Biofilms. Remember that slime you slipped on at the beachfront?
That was a biofilm, a community of bacteria and other organisms
that are an elemental aspect of life on Earth in all their myriad forms.
The biofilm you will see the most is plaque biofilm, or the normal
condition of the mouth. Like other biofilms in the body, it has its
purpose. For example, the thick biofilms that coat the digestive tract
absorb vitamins and carbohydrates that we are unable to digest on
our own. Biofilms contribute directly and indirectly to the physiology,
nutrition, and immunology within our bodies. Caries and periodontal
breakdown occur at specific sites where the biofilm gets out of bal
ance. The composition of the biofilm is sensitive to local environmen
tal factors, such as diet, antimicrobials, salivary flow, and even stress.
The National Institutes of Health has invested millions of dollars
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in oral biofilm research, with more to come, because maintaining
biofilm will be the cornerstone of dentistry in the future. It’s coming.
Will you be ready?
3
“Continuing education is
a lifelong obligation. And
not only is it a professional
Personal Growth
responsibility, but it is also a
There was a time when almost every dentist had a solo practice, and
while there are more dental practice groups than ever, solo practice
is still the way most dentists prefer to go about their business. Solo
practice offers many advantages, primary among them the ability to
be the captain of your own ship. The potential downside is isolation,
a lack of communication, and a loss of perspective. It’s tempting to
fall into a set pattern in dental practice, especially one that seems to
satisfy patients and answer to the bottom line. If you practice alone,
there’s always that risk. The broad category of “personal growth” is
a preventive tool that helps dentists avoid stagnation and a lack of
creativity, on and off the job. The interaction built into continuing
education can be an antidote to that poison. You can learn far more
than the latest crown technique from a roomful of dentists who share
your interests, starting with personal and professional poise. Every
time you open yourself to new possibilities, you are growing person
ally. You don’t necessarily need continuing education to accomplish
that, but continuing education makes that journey easier and more
fulfilling. You don’t have to be a social butterfly or a classic “go-get
ter” to achieve personal growth either; you just need to be motivated.
Professional Growth
Those two words are what keep the AGD going, and growing, day to
day. In the early days, AGD pioneers believed that in order for health
professionals to stay informed of current advances, it would be neces
sary for them to earn continuing education credit. That philosophy
hasn’t changed in more than 50 years, and continuing education has
become big business. As the organization grew, members increasingly
made demands for the quality and challenges that continuing educa
tion could provide. Those demands for sources of professional growth
led to the creation of the AGD Fellowship and Mastership awards.
Over the past 55 years, more than 13,500 general dentists, more than
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professional reality.”
Howard S. Glazer, DDS, FAGD
Fort Lee, N.J.
New York University College of
Dentistry, 1975
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Chapter 8
“Early on in my career, I realized that dental school left a lot of voids in my education. I started going to continuing education courses and quickly found out that there were so many alternative materials and methods to help improve my techniques, as well as knowledge that I needed to obtain. My confidence rose dramatically when I saw things that reinforced what I was already doing and, as my skills broadened, I could provide more services to my patients.”
David F. Halpern, DMD, FAGD, FACD
Columbia, Md.
AGD Secretary, 2006-2007
Fairleigh Dickinson University School of Dentistry, 1978
one-third of the AGD membership, have earned Fellowship and more
than 2,000 have gone on to earn Mastership. These demanding pro
grams represent nothing less than a commitment to lifelong learning
and quality patient care. Even AGD members who haven’t earned
Fellowship view it as valuable; a 1999 survey revealed that 75 percent
of respondents said they planned to pursue the Fellowship Award.
Today, AGD members are required to earn 75 hours of continuing
education over a three-year period. Once based on an honor system
for completion of the required hours, the Fellowship Award is now
based on a monitored core competency requirement, which has re
sulted in more than 4,000 members being withdrawn from the ranks
for not meeting the requirement.
AGD statistics indicate that their members average 43 hours of CE
each year, or 129 hours in each three-year period. The organization
continues to balance the quality versus quantity issue by considering
options that would mandate the types of courses taken for member
ship maintenance and what the impact on the organization might be.
Types of Continuing Education
Fulfillment of your professional and personal requirements can take
several forms:
Hands-on courses. The treatment of live patients in a clinical set
ting may be the most rewarding continuing education experience.
Since you’re working on real people, you can quickly apply what
you’ve learned to your own clinical repertoire. Usually available at
some dental schools, private continuing education organizations,
study clubs, and clinics set up by manufacturers, these continuing
education opportunities require your own supplies and equipment, a
license to practice at the course location, and significant tuition. Yet,
for all that they cost in time and money, these hands-on courses are
highly educational.
Simulated clinical settings. Working on models may be the next
best thing to live patients, since it offers most of the advantages
inherent in live patients, yet avoids some of the disadvantages. You
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Chapter 8
33
can take a simulated clinical course wherever it is held regardless of
your licensure, plus you avoid pitfalls, such as patients with a low
discomfort threshold and personality issues, and you can make mis
takes without regret. Under the observation of a veteran dentist and
teacher, your work in these courses can be highly valuable.
Live Video DVD/VHS. More and more, high-quality digital video
is being developed for use in dental continuing education courses.
Rapid advances in digital and computer technology, just since the
year 2000, have led to the development of some amazingly sophisti
cated and realistic course programs. The clearest advantage for the
lifelong learner is that you can view the course at your own pace,
then go back and review it again whenever you feel the need. You
can pause the presentation at any time you want in order to do some
thinking. You also can review a single section again and again. This
is a newer, higher level form of dental continuing education that has
many advantages and a few potential drawbacks. Mostly, those dis
advantages have to do with the date of production and whether the
course has been updated. While there are some “evergreen” presenta
tions that withstand changes in the profession and the test of time,
there are many more that can go out of date within a few years, or a
few months. Just be aware that as long as a digital course continues
to sell, it will continue to be offered, often regardless of content. You
can avoid those traps by seeking out experienced, respected, and
widely-known educators who clearly stand by their courses.
Video. Continuing education on VHS tapes can and often does
contain the same information found in a DVD course, but you’ll be
doing playback manually, hoping you stop at the right place to view a
certain procedure over again. Of course, these stopping places can be
notated but you are still spending time going back and forth. Regard
less, this course format represents a significant portion of the dental
continuing education that is available and will be around until DVDs
or other digital formats phase them out completely.
Seminars. A seminar involves interaction between the presenter and
the audience, usually in the form of question and answers, breakout
sessions, and other interactive approaches. Seminars provide a feeling
of immersion on a particular topic because of the constant interac
tion. The key to its effectiveness is the background and skills of the
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You don’t have to be a
social butterfly or a
classic ‘go-getter’ to
achieve personal growth;
you just need to be
motivated.
3
Chapter 8
“Helping plan CE for the
Arkansas AGD has allowed
me to dine with some of the
greatest minds in dentistry
and listen in on in-depth
conversations between my
mentors and my heroes.
Wow!”
Kenton A. Ross, DMD, FAGD
Fayetteville, Ark.
ASDA National President,
1994-1995
University of Louisville, 1995,
University of Tennessee, 1996
facilitator. Without a quality facilitator who understands the dynam
ics, the experience can be time-consuming and frustrating.
Lectures. This is the dominant form of continuing education out
there; lecturing is basically a seminar without the interaction. Lecture
format continuing education can be very effective when the presenter
uses a form of Socratic teaching in which he or she asks questions
that each participant will individually, and silently, answer, in turn
stimulating an individual thought process that will pay dividends in
the treatment room.
Dental journals. To help wade through the reams of dental articles
placed in various dental journals every month in order to get to the
relative few that actually apply to your practice, refer to the few
“trustworthy” publications and eliminate the rest. Create a file for
your articles of interest and put the information into practice. (Don’t
forget to purge these article files at least every five years.)
Internet. Until the market for this breakthrough format matures,
it will be of limited value since many Internet-based continuing
education programs have already come and gone. Still, Internet-based
continuing education has great potential and could become a domi
nant form of continuing education programs when the bugs, such as
inferior images and the tendency to linger in the Internet pipeline
without change, are worked out.
As was alluded to earlier, your professional growth depends on
continuing education. By and large, dentists become members of the
AGD because they want to enhance their practice and professional
capabilities through continuing education. Today, the AGD member
ship of 35,000 speaks to the enlightened approach that many dentists
gladly take toward a satisfying practice and satisfied patients.
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Chapter 9
Organized Dentistry
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Chapter 9
Organized Dentistry
The “Why” of It
You’ve no doubt heard the old adage that “there is strength in
numbers.” It’s worth considering the fact that every maxim has its
foundation in truth. Sayings become adages because they serve to
illustrate useful knowledge. And knowing that you can turn to people
and places where you receive support in a complicated profession is
worth more than the sum of the parts.
To decide what
organization to join—
There’s another old saying: “All for one, one for all.” You might roll
your eyes, but that’s how organized dentistry works—strength in
numbers. People to turn to in a crisis, mentors who can answer tough
questions with the voice of experience, benefits you can’t get any
where else, and the security in knowing that there is a place to turn
at any given time and in any given situation. Why wouldn’t you want
hundreds of experts available—just an e-mail or phone call away?
and maybe more than
one is right for you—
do a little soul searching
combined with fact
checking.
Member dentists love to help their colleagues. That’s been dem
onstrated over and over through committees and special projects
that gather some of the best minds in dentistry to tackle some of
the toughest challenges you’ll ever face in your personal practices.
Dentistry remains a respected and trusted profession largely because
of the public image it conveys, thanks to organized dentistry. New
dentists also can look forward to a financially rewarding career, again
largely due to the continued efforts of organized dentistry.
Professional Relationships
One of the major advantages—and potential disadvantages—of
dentistry as a profession is the tendency for most dentists to practice
as sole proprietors. Traditionally, dentists like to practice that way be
cause they control their own destiny and avoid what many perceive
as interference with their best judgment and professionalism. The
potential downside, of course, is isolation.
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Organized Dentistry
By their nature, human beings like things to remain the same. All of
us like to find comfortable niches and remain there. Many people are
motivated by personal reasons to break through that comfort level;
many are not. In dentistry, practicing solo can enhance that comfort
level while subtly validating isolation, particularly if your practice
is successful. Still, many people consider success to be the ability
to change. Professional relationships via participation in organized
dentistry open a huge door for interaction that prompts positive
change. This doesn’t mean you had to have won the congeniality
award in high school in order to interact and socialize with others.
Many quiet, reserved dentists take part in the Academy of General
Dentistry (AGD) and other organized dentistry. That’s the beauty of
it—you don’t have to be a certain type of person to take part and reap
the benefits. You just have to participate.
You never know where a bit of good advice may arise. It could come
in a phone conversation with a colleague you’ve gotten to know down
the street. It could come while you’re sitting at a table waiting for a
seminar to begin. It could come in the mail. In any case, you have to
wade in the pool in order to bump into another swimmer.
You’re on the verge of making the huge leap from school to prac
tice, which is a natural time to get involved with other dentists and
dental team members. You will never know as much as the combined
knowledge of other people in the profession, so get to know them
and take advantage of what they have to offer. And remember, they
started out just like you. Wisdom is accumulated slowly, but it is ac
cumulated. Since you have to start somewhere, why not start now?
It’s a perfect time.
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Chapter 9
3
“This chapter on organized dentistry makes a detailed, passionate argument on why it is essential for a new practitioner to belong to organizations such as the Academy of General Dentistry. The authors have provided the young dentist with four essential reasons for joining organized dentistry. After reading this chapter, it would be very hard to not see the benefits of belonging to an organization of your peers.”
Raymond K. Martin, DDS, MAGD Mansfield, Mass.
University of Texas Health Science Center at San Antonio, 1983
3
Chapter 9
Organized Dentistry
“My 20-plus years as a
practicing general dentist—
a solo practitioner—have been
enhanced tremendously by my
membership and participation
in organized dentistry. My
membership in dental
organizations has helped me
to make friends in many other
circles, and I have learned
something from every one of
them. My career in dentistry
has been a joy because of the
friends I have made.”
Paula Shannon Jones, DDS,
FAGD
Defiance, Ohio
AGD Vice President,
2006-2007
Case Western Reserve
University School of Dental
Medicine, 1984
With all due modesty, dental continuing education would not be
where it is today without the efforts of the AGD. In the 1950s, the
organization planted the seeds that would become the most effective
model for continuing education in the United States. By the 1970s,
the AGD’s concept of continuing education was firmly established
in the dental profession. As the organization grew, members made
increasing demands for the quality and challenges that continuing
education could provide.
Ten years after the founding of the AGD, the first Fellowships were
awarded to 21 intrepid dentists. By 1968, the Mastership program
was developed to provide additional education for dentists who
wanted to continue their progress. Today, more than 13,500 AGD
members have earned Fellowship and more than 2,000 have earned
Mastership as a personal challenge and a sign of achievement. This
is a commitment to lifelong learning and quality patient care and
nothing less.
More than ever, you need continuing education. The entire body of
knowledge in dentistry changes every three to five years. This means
that new concepts and materials replace existing ones very quickly
and, thus, you must stay on top of these changes to effectively
delivery good patient care. As a young dentist today, you will
encounter during your career nanotechnology, genetically engineered
tooth structure and soft tissue, materials that haven’t been invented
yet, and techniques that would seem like science fiction now. Twenty
years ago, implants were largely considered experimental and few
general dentists knew the procedure. Ten years ago, composite
resins still couldn’t withstand the chewing pressures of the posterior
teeth. Today, they are widely used in almost all clinical restorations.
Just think of the changes that occurred during your years of dental
school. As hard as they try, dental schools have only enough time
to teach the basics of clinical dentistry. Advances in dentistry move
very rapidly and sometimes are beyond the academic environment
from either a financial position or the skill level of the dental student.
Fortunately, the dental profession has been a leader in continuing
education. Today you can learn just about anything you want to
learn, given some motivation and time. It’s up to you.
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Organized Dentistry
Chapter 9
3
Organized dentistry makes it easy to find the continuing education
course you need in your community. When you join an organization,
your ready access to quality continuing education may be the biggest
benefit of all.
Philanthropy
Organized dentistry has a long history of support for, and participa
tion in, programs that help improve the oral and general health of
populations in need. While you were in dental school, you may
have been part of similar efforts supported by your university. If
so, you understand how important disease prevention and dental
treatment are to thousands of people in the United States and abroad.
Philanthropy is about giving back and, as has been the case time and
time again, about getting back. There is no greater gift than the smile
of a child who is relieved of pain and discomfort. There is no better
gift than reaching an elderly, homebound patient with portable dental
equipment, a patient who otherwise might suffer in silence. Den
tistry, by its nature, is a giving profession. We help people maintain
their oral and general health for a lifetime, so it makes perfect sense
to be involved in programs that reach those who can’t walk into your
practice for care.
When dentists—young, old, and in between—take an active role
in spreading the advances in modern health care, we all benefit,
because we are all connected in some way. Remember “six degrees
of separation”? Basically, it means that if a person is one “step” away
from each person he or she knows and, therefore, two “steps” away
from each person known by those he knows, then each person in the
world is no more than six “steps” away from everyone else. What this
says is that it is, indeed, a small world, and philanthropy helps others
while contributing to your growth as a professional and a person.
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Dentistry is always
changing. Participation
in organized dentistry
is the best way to keep
track of those changes—
and to make some
yourself.
0
Chapter 9
Organized Dentistry
Socialization
“Unfortunately, many dentists
are so content in their own
world that they don’t realize
the need to participate in
organized dentistry until a
crisis situation erupts and
changes their world. It is vital
for all members of the dental
profession to be involved in
organized dentistry in order
to be effective in dealing with
legislation, governmental
regulation, and the
ever-changing world in which
we practice our profession. It
is unfortunate that many
dentists never avail themselves
of the wonderful opportunities
available to them.”
Howard R. Gamble, DMD,
FAGD
Sheffield, Ala.
AGD Speaker of the House, 2005 – University of Alabama School of Dentistry, 1967
This is what could be called a no-brainer. The channels through
which you meet colleagues exist in abundance at the level of orga
nized dentistry. There are thousands of dentists and dental team
members out there, each with a unique viewpoint. Experience will
demonstrate that you can learn and grow through interaction with
virtually anyone—dentist or not—when you take the time and use the
energy to relate to that individual.
Clearly, socialization is a great deterrent to isolation, which can hap
pen to people in any walk of life. As was said earlier, dentists in par
ticular can fall into that trap, especially if they run a solo practice or
do most of their work alone. Socialization runs a huge gamut; it can
mean lunch with your team at the local deli, or it can mean formal
dress and a gala at a local museum. In any form, it means contact
with others outside the context of your practice.
Organized dentistry is tailor-made for socialization. You can get in
volved in any number of projects with any number of people simply
by joining an organization and dipping your toe into the water. Start
slowly at first and then gain momentum as you find your place in
an organization and amongst your peers. Who knows? Your persona
may blossom from contact with others. On the flipside, if you are
quiet and reserved and are comfortable that way, stay that way.
Socialization is simply a way to avoid becoming stale. Yeah, it’s a
corny old song, but people really do need people, and people who
need people are “the luckiest people in the world.” We were all born
to interact, it’s our nature. Organized dentistry makes it easy and
painless.
Which Organization Is Right for You?
To decide which organization to join—and maybe more than one
is right for you—do a little soul searching combined with fact
checking. Remember our goal setting chapter? We want to set our
career on a path that takes us closer to our ultimate goal—not one
that takes us further away. What do you want out of your career as a
dentist? Where are the best places to find what you need? Different
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Organized Dentistry
Chapter 9
organizations have different emphases and resources. The AGD,
as you know, focuses on general dentistry. It caters to the general
dentist’s needs; it is an organization run by general practitioners for
general practitioners who share a sincere and deep appreciation for
the value of continuing education. Members of the AGD seek contin
ued professional development and advancement on behalf of quality
patient care. The American Dental Association, the nation’s >>
One of the most important reasons for becoming a member of any organization is the
representation and advocacy they can provide on your behalf. The following are just a couple
examples of how the AGD is supporting its members.
Example No. 1: Rep. John Dingell (D-MI-15) has introduced his “Children’s Dental Health Improvement Act
of 2007” (HR 1781), which would provide disadvantaged children with access to dental services, includ
ing allowing states more flexibility in covering dental services through the State Children’s Health Insurance
Program (SCHIP). The AGD has supported this bill in the past and will do so during the 110th Congress.
Passage of this bill is of the highest priority for the AGD. Access to oral health care nationwide—
especially for children—is its top legislative goal, and this bill provides many very positive provisions that
will prove beneficial and help to achieve this goal. Introduction of this bill provides the AGD with a unique
opportunity to display its proactive grassroots advocacy campaign and make a big difference not only on
Capitol Hill, but on the nation if the bill is signed into law.
Example No. 2: The AGD’s statistical map entitled “The Economic Contribution of the Dentistry Profession
in 2005” details how many workers are employed in the oral health sector in each congressional district and
state, as well as the annual payroll of these employees. One goal of this statistical information is to inform law
makers on Capitol Hill just how much the dentistry profession contributes to their congressional districts and
states, both in terms of number employed and payroll totals. The AGD asks lawmakers to consider constitu
ents employed in the oral health profession as they make decisions on legislative initiatives impacting general
dentistry.
Example No. 3: The AGD is watching legislative and regulatory activity in several states. Issues include anes
thesia and possible increased Medicaid payments for some dentists.
These examples only represent the tip of the proverbial iceberg. Every day, somewhere, the AGD is repre
senting the interests of general dentists, either through participation in formal legislation at the local, state,
or federal government level, or through committee and council channels. Dentistry is always changing.
Participation in organized dentistry is the best way to keep track of those changes—and to make some your
self. If you are unhappy with the way things are being run in an organization, or you envision a way to make
it better, then join, participate, and make those changes.
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Chapter 9
“The predominant reason for my activity in the Academy of General Dentistry centers
around relationships and personal growth. Friendships and camaraderie are cornerstones of the Academy of General Dentistry experience, and they represent the culture of the organization. I get energized each time I interact with my Academy of General Dentistry friends, which recharges my professional ‘battery’ and enhances my ability to have continued success in my practice.”
David F. Halpern, DMD, FAGD, FACD
Columbia, Md.
AGD Secretary, 2006-2007
Organized Dentistry
largest dental organization, has an incredible depth of resources that
can be of great value, especially to a young dentist who is finding his
or her way step by step.
If you plan on practicing as a general dentist, check out the AGD and
see what such an organization devoted to the general practitioner can
offer. For instance, the AGD facilitates the practice of the profession
for general dentists by investigating and determining policies that
advance dentists professionally and provide optimal dental care
for the patient. The AGD also meets with organized dentistry, the
governmental agencies charged with overseeing oral health, and with
third-party carriers, in order to represent and advocate the positions
of the general dentist.
There are other advantages to joining organizations. For instance,
by joining the AGD, you can take advantage of award-winning
publications that keep you up-to-date on changing technology and
procedures that help you meet the demands of dental practice in
the 21st century. Time-saving, easy-to-use guidebooks help you find
a path through the forest of OSHA regulations and other practice
requirements. Marketing materials provided by the AGD will help
you to quickly raise your visibility in a new community, while
serving to educate your current and prospective patients on all that
modern dentistry has to offer.
Of course, there also is low-cost, high quality continuing education
offered by the AGD’s 62 constituents, all conveniently located and
tailored to meet local interest and your needs. The AGD’s Fellowship
and Mastership award programs are unique in organized dentistry.
By reaching the recognized standards of excellence inherent in those
programs, you are assuring your patients and the public that your
skills are leading edge and informed. You are advertising, if you will,
that your knowledge and clinical skills continually evolve.
And then, there’s savings on a variety of practice management
newsletters and educational materials, office supplies, an Affinity
credit card, a competitive patient bank card that enables them to
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Organized Dentistry
charge dental services while you receive payment at the time of
service, a wide range of health and life insurance plans, a member
ship directory that helps you reach out to others in your field,
discounts on moving and car rental costs, discounts on overnight
letters and packages, and low-cost liability insurance. Sure, many
young dentists join organized dentistry just for the liability insurance,
given the litigious times in which we live, but there’s so much more
to the AGD than meets the eye.
In any case, do your homework. You’ve just spent many years
diligently doing your homework, so don’t stop now! Use your skills
to identify the right organization for you. It will become apparent
where you belong, if you put time and effort into your research. And
remember, you can almost always reach out and contact a member of
the AGD or of other dental organizations from anywhere you are, so
start asking questions!
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Chapter 9
3
Chapter 9
Organized Dentistry
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Chapter 10
The
Beginning
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Chapter 10
The Beginning
The Beginning
“The first thing I realized
after graduating from dental
school and starting my own
practice was how little I knew
about running a business. The
tremendous advice and
information offered in this
manual should benefit you
whether you decide to start
your own practice or you
enter an associateship or a
partnership.
“I sincerely hope all of the
hard work and energy that
has been put into this manual
will help make your life easier
and more fulfilling. I am proud
to have had the opportunity
to serve as president of an
organization whose members
are so dedicated to lifelong
learning, optimal patient care,
and concern for our future
colleagues and leaders. My
congratulations to all of you!”
Bruce R. DeGinder, DDS, MAGD
Williamsburg, Va. AGD President, 2006-2007 Virginia Commonwealth University School of Dentistry, 1988
Your journey into practice is about to begin. You may be feeling a bit
overwhelmed. Remember that this manual is essentially a reference
tool that you can turn to when you get stuck or need a reminder of
how to get from one point to another in your preparation for practice.
By no means is this manual all-inclusive, but it can help you stay
calm in the transition.
The first rule of dentistry is that you never stop learning. Your
dental education continues even after you enter the “real world.”
You will experience a learning curve, so do yourself a favor and
accept it. Relax. You will get far more right than you will get wrong,
particularly if you take your time. You are, of course, encouraged to
take as many continuing education classes and seminars as possible.
Your dental education has prepared you to go forward with the basic
knowledge and skills you need to get started. Now, it’s up to you to
keep an open mind to new techniques, procedures, and instruments.
When you begin to make inquiries during the initial set-up stages
of your practice, you will find yourself bombarded with offers from
individuals and companies who seem to know best. Again, slow
down and weigh these offers carefully and with a critical eye. You
can help yourself slog through this period by joining a professional
society, such as a local dental association and/or study club. If you’re
going to practice as a general dentist, consider joining the Academy
of General Dentistry (AGD). Why? Because the AGD was created so
general dentists would have a place to call home and it has grown
on that premise, particularly when it comes to participating in
continuing education as a way to grow your practice and yourself.
There are thousands of great dentists out there, many of whom enjoy
imparting their accumulated wisdom, which, in some cases, was
acquired through trial and error. Get to know veteran dentists in your
area and visit their practices. Take note of what you admire about
them, their practices, and their way of doing business, and learn from
it. No one said you have to reinvent the wheel, so get tips and advice
from wherever you can. And get expert help where you need it. This
is no time to be penny-wise and pound-foolish, as the old saying goes,
so take advantage of experts and specialists who can save you a lot of
time, grief, and, in the big picture, money.
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The Beginning
Isolation is your enemy and tends to creep up on professionals who
largely spend their days running their own businesses. Dentists are
particularly susceptible once they feel they have found their groove.
While it’s great that you finally feel comfortable in your practice, you
can be sure that as soon as that happens, change will come knocking
again.
Dentistry is undergoing a sea of change, fulfilling a promise that
began as a twinkle in the 1950s, and expanding to a very bright light.
Dentists are truly becoming “physicians of the mouth,” health profes
sionals who have an important role not only in oral health mainte
nance but in general health maintenance as well. The mechanical
paradigm of old is giving way to a holistic approach that takes well
being into account.
All of these changes mean an exciting time for you. It is, without
exaggeration, an incredible time to be a dentist. Over the course of
your career, the profession is going to continue to evolve. Sure there
will still be restorative work, but if the profession continues down
its chosen path, restorative work will not be what fills your schedule
every day. Prevention, early diagnosis, and health maintenance will.
We hope that this manual gives you a leg up in some way, because
as much as dentistry is an art and science, it is equal parts business.
You will find, as every dentist does, that the needs of your business
will constantly intersect with the needs of your practice and your
patients. If you plan ahead, however, and make sure that you have
your business set up to operate successfully, you’ll also find that
while business won’t take care of itself, it will need a lot less babysitting over time. Your patients will appreciate your approach to
practice, and you will be able to appreciate your patients.
Chapter 10
“If there is one thing to remember as you enter into the ‘real world,’ it is that you are not alone. “As dentists, we share a bond that is based on a common understanding of the rigors of our early and lifelong educational process and the pursuit of perfection that we undertake in our clinical practice every day. Always remember the gift that you now hold in your mind and in your hands. And, while your financial reward awaits, the greatest joy is in giving back. To quote Sir Winston Churchill: ‘We make a living by what we get, we make a life by what we give.’
“I wish you the best as you embark upon your new career.”
Vincent C. Mayher, DMD, MAGD
Haddonfield, N.J.
Best wishes as you enter the world of dental practice!
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Chapter 10
The Beginning
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Your Checklist
to Success
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Your Checklist to Success
The following list can help you organize your “to do” list into something comprehensible. With all that you
have to take care of, leading up to the day you open your office, you need a checklist as a reminder. It always
helps to see concepts on paper; for some reason, humans respond to lists with motivation and a sense of
urgency. Plus, having it on paper can help relieve some of the stress you might feel from trying to carry a list
around in your head all the time—and trying to remember everything you need to remember. So, consult the
checklist as required, and take it one task at a time.
q
Obtain Dental License.
__________________________________________________________________________________________
__________________________________________________________________________________________
q
Evaluate Goals.
__________________________________________________________________________________________
__________________________________________________________________________________________
q
Formulate Business Plan.
__________________________________________________________________________________________
__________________________________________________________________________________________
q
Select Geographic Area.
__________________________________________________________________________________________
__________________________________________________________________________________________
q Business Needs
___________________________________________________________________________________
___________________________________________________________________________________
q Personal Needs
___________________________________________________________________________________
___________________________________________________________________________________
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q
Select Specific Practice Location.
__________________________________________________________________________________________
__________________________________________________________________________________________
q Demographics
___________________________________________________________________________________
___________________________________________________________________________________
q
Visibility
___________________________________________________________________________
___________________________________________________________________________
q
Accessibility
___________________________________________________________________________
___________________________________________________________________________
q
Urban
___________________________________________________________________________
___________________________________________________________________________
q
Suburban
___________________________________________________________________________
___________________________________________________________________________
q
Rural
___________________________________________________________________________
___________________________________________________________________________
q
Home Office
___________________________________________________________________________
___________________________________________________________________________
q Real Estate Issues
___________________________________________________________________________________
___________________________________________________________________________________
q
Purchase
___________________________________________________________________________
_________________________________________________
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q
q
Leasing
___________________________________________________________________________
___________________________________________________________________________
Develop a Budget.
__________________________________________________________________________________________
__________________________________________________________________________________________
q Business
___________________________________________________________________________________
___________________________________________________________________________________
q Personal
___________________________________________________________________________________
___________________________________________________________________________________
q
Acquire Support Staff.
__________________________________________________________________________________________
__________________________________________________________________________________________
q Bankers
___________________________________________________________________________________
___________________________________________________________________________________
q CPA
___________________________________________________________________________________
___________________________________________________________________________________
q Insurance Agent
___________________________________________________________________________________
___________________________________________________________________________________
q Financial Planner
___________________________________________________________________________________
___________________________________________________________________________________
q Practice Management Consultant
___________________________________________________________________________________
___________________________________________________________________________________
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q Attorney
___________________________________________________________________________________
___________________________________________________________________________________
q Dental Supplier
___________________________________________________________________________________
___________________________________________________________________________________
q
Establish Regulations Protocols.
__________________________________________________________________________________________
__________________________________________________________________________________________
q OSHA
___________________________________________________________________________________
___________________________________________________________________________________
q HIPAA
___________________________________________________________________________________
___________________________________________________________________________________
q
Start Building or Leasehold Improvements Process.
__________________________________________________________________________________________
__________________________________________________________________________________________
q Develop Architectural Plan
___________________________________________________________________________________
________________________________________________________________________________
q Contact Builders for Estimates
___________________________________________________________________________________
________________________________________________________________________________
q Acquire Building Permits
________________________________________________________________________________
________________________________________________________________________________
q Finalize Floor Plan Details
________________________________________________________________________________
________________________________________________________________________________
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q Acquire an Interior Designer
________________________________________________________________________________
________________________________________________________________________________
q
Determine Equipment, Fixtures, Supplies, Instruments, and Signage.
________________________________________________________________________________________
________________________________________________________________________________________
q
Determine Financing Needs and Resources.
________________________________________________________________________________________
________________________________________________________________________________________
q
Finalize Financing.
________________________________________________________________________________________
________________________________________________________________________________________
q
Order Equipment, Fixtures, Supplies, Instruments, and Signage.
________________________________________________________________________________________
________________________________________________________________________________________
q
Select Telephone, Intercom, and Music System.
________________________________________________________________________________________
________________________________________________________________________________________
q
Begin Construction.
________________________________________________________________________________________
________________________________________________________________________________________
q
Order Telephone Number and Yellow Pages Ad.
________________________________________________________________________________________
________________________________________________________________________________________
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q
Design Office Logo and Develop Brochure.
__________________________________________________________________________________________
__________________________________________________________________________________________
q
Obtain All Provider Numbers.
__________________________________________________________________________________________
__________________________________________________________________________________________
q DEA
________________________________________________________________________________
________________________________________________________________________________
q State Drug Registration
________________________________________________________________________________
________________________________________________________________________________
q Insurance Companies
________________________________________________________________________________
________________________________________________________________________________
q Occupational Licenses
________________________________________________________________________________
________________________________________________________________________________
q Medical Provider
________________________________________________________________________________
________________________________________________________________________________
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q
Develop Written Office Manual.
__________________________________________________________________________________________
__________________________________________________________________________________________
q Develop Mission Statement
________________________________________________________________________________
________________________________________________________________________________
q Establish Systems Protocols
________________________________________________________________________________
________________________________________________________________________________
q
Description of System
___________________________________________________________________________
___________________________________________________________________________
q
Detailed Job Description
___________________________________________________________________________
___________________________________________________________________________
q Develop Written Financial Policy
________________________________________________________________________________
________________________________________________________________________________
q
Methods of Payment
___________________________________________________________________________
___________________________________________________________________________
q Types
____________________________________________________________________
____________________________________________________________________
q Scripts
____________________________________________________________________
____________________________________________________________________
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q
Collections
___________________________________________________________________________
___________________________________________________________________________
q
Process
___________________________________________________________________________
___________________________________________________________________________
q Staff
________________________________________________________________________________
________________________________________________________________________________
q
q
Compensation
___________________________________________________________________________
___________________________________________________________________________
q
Performance Reviews
___________________________________________________________________________
___________________________________________________________________________
q
Job Descriptions
___________________________________________________________________________
___________________________________________________________________________
q
Benefits Package
___________________________________________________________________________
___________________________________________________________________________
Open Business Banking Account.
__________________________________________________________________________________________
__________________________________________________________________________________________
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q
Begin to Advertise for Staff.
__________________________________________________________________________________________
__________________________________________________________________________________________
q
Begin Telephone Service.
__________________________________________________________________________________________
__________________________________________________________________________________________
q
Make Arrangements for Waste Service.
__________________________________________________________________________________________
__________________________________________________________________________________________
q
Make Arrangements for Janitorial Service.
__________________________________________________________________________________________
__________________________________________________________________________________________
q
Begin Practice Promotion.
__________________________________________________________________________________________
__________________________________________________________________________________________
q
Monitor and Make Adjustments.
__________________________________________________________________________________________
__________________________________________________________________________________________
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At the Academy of General Dentistry (AGD), we realize that as dental students and recent gradu
ates, you have limited time and resources as you prepare for and begin your career in dentistry.
The AGD has developed this student manual and many other resources to help you get started in
your dental career and get involved in organized dentistry.
Why is this important to you? AGD dentists recognize the importance of lifelong learning and
continuing education to promote optimum oral health care. They go above and beyond the
basics of dentistry by increasing their knowledge and expertise to provide the very best in oral
health. As a student or recent dental school graduate, you are looking to stand out from the
crowd. What better way to do so than to belong to an organization that helps you to get there?
Because we understand the financial burden of most students and recent graduates, the AGD
offers dental students and recent graduates significant discounts on dues for up to four years
out of dental school.
Other AGD benefits for dental students and residents include:
Residency Credits. Acquire up to 250 hours of continuing education (CE) credit toward the
Fellowship Award upon completion of an AEGD or GPR program. That’s half the total required
hours! If you are not currently a member, be sure to join within a year of completing your
residency in order to receive these important credits.
AGD Career Center. With this AGD Web site feature, you can post your résumé or curricu
lum vitae online for employers to view, as well as view potential employment opportunities.
Reduced Fees at the Annual Meeting. Receive valuable CE credits for a fraction of the
cost! Dental students attend the meeting for free, and residents pay a discounted registration
fee at the AGD Annual Meeting. Registration includes lectures, capsule clinics, and entrance to
the Exhibit Hall.
Subscriptions to AGD Publications. Subscriptions to the AGD’s publications General
Dentistry and AGD Impact are included in your discounted membership fee. AGD Impact will
keep you up-to-date with all the current news in general dentistry, and our scientific journal,
General Dentistry, will inform you of all the latest advancements in your field. Articles also are
available online for your reference.
AGD Benefits Plus. Save money and time by using AGD Benefits Plus programs to help you
get started. Our Benefits Plus partners offer savings on programs and services for loan repay
ment, insurance, financing, credit card processing, and more.
Become a member! For more information or to join today, visit us at www.agd.org,
call us at 888.243.3368, ext. 5300, or send an e-mail to [email protected].
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Protection you can count on…. Dentist’s Advantage is your resource for individual professional
liability insurance for you and your dental practice. Through our relationship with Fireman’s
Fund Insurance Company, rated “A” (Excellent) by A.M. Best, we are able to provide dentist
malpractice insurance, property protection insurance for your practice, and workers’ compensa
tion insurance coverage. Dentist’s Advantage is proud to have earned the endorsement of the
Academy of General Dentistry.
www.dentists-advantage.com
866.219.6533
Dentist’s Advantage offers:
• Discounts on professional liability insurance:
* 10 percent to AGD members
* 15 percent to Fellows
* 20 percent to Masters
• New dentist (graduates) discounts
• Claims free discounts
• Risk management discounts
Property, general liability, workers’ compensation, and a range of other coverage are available.
Student Liability Insurance
• Available through www.dentists-advantage.com.
• Student/resident members are eligible for student liability insurance to cover them during
board examinations. Available to recent graduates and non-students on a case-by-case basis.
• Certificate automatically includes 12 months of “interview” coverage. Does your potential
employer need to see what you can do? Now you can show them without fear of a
malpractice claim.
• Dentist’s Advantage Student Liability Insurance is available for $25.
• You are covered for one full year from your certificate date.
• Coverage is $1,000,000 per incident/$3,000,000 aggregate.
• If you purchase professional liability from Dentist’s Advantage, you will receive a $25 credit on
the first year of your policy.
Dentist’s Advantage is a division of Affinity Insurance Services, Inc.
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You`ve Graduated, Now What? - Academy of General Dentistry

Transcription

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