Cliff's Notes

The Business of Dentistry

Is Cad Cam Old Technology?

See the source image

What a Long Strange Trip It’s Been … Jerry Garcia … 2020 has come and gone and the residual effects will be with us for a long time.

Dental offices were shut down for months and the balance of the year was dedicated to playing catchup and figuring out how to continue running a profitable practice and accounting for all the additional expense.  The prices on PPE have more than tripled and you usually have to settle for what you can get. As a senior member of the dental industry with 45 years under my belt, I can assure you that prices won’t start stabilizing for some time to come. And, when or if a competitive market returns, it will never be lower than now. So what can we do about it? We need to keep as much as possible under one roof.

Cad Cam has been a dream that most dentists share, but at $150k with $3k-$5k in annual support costs and office would need to use the mill 20 times/month to break even. Cad Cam was introduced to dentistry over 35 years ago and it has advanced to become almost a sub-culture. Although Cad Cam fits well with larger practices, tell me what it can do that 3D printing can’t?

That’s right, 3D Dental Printing. During the shutdown and the following months with the new company, I became very interested in 3D Printing in Dentistry. There are a lot of 3D printers on the market  but only a few are dental specific. Dental specific means that the printer has been validated for dental resins. Dental Resins are approved by the FDA and the companies that make them have to validate every brand and model printer that their products will work with. That is the responsibility of the printer manufacturer. As an example, one of the top resin manufacturers in the world developed an incredible resin to produce custom night guards that are flexible and almost non breakable. A $450.00 bottle of resin will produce 75 night guards. Do the math! Now that is ROI.

Sometime in the next 18 months the FDA will be approving resins to produce permanent crowns. And did I mention that you will be able to print your own clear aligners. That, however, will require software for your impression scanner.

Dental 3D Printers are “plug & play” and will work with any impression scanner. Impression scanners have really advanced and there should be no reason why you should spend more than $20k on a scanner. Now you have a scanner/printer package for under $30k that in the very near future will do more than a Cad Cam System. 

In my personal opinion, 3D printing will become a standard in same day dentistry. I think that in the next 5 years every dental office will have a 3D printer. If you have an impression scanner your next investment should be a printer. If your financial advisor suggested an investment that would double in value in 6 months would you do it? A scanner/printer combo is under $30k and if used correctly, will pay for it’s self in less than 6 months (most practices) and from then on it’s all new revenue.

Explore 3D Dental Printing, it will impress your patients and have a positive effect on your practice.

Please feel free to contact me at any time with any questions or concerns.

January 19, 2021 Posted by | Uncategorized | Leave a comment

“Everyone has a plan, Until they get punched in the face!” … Mike Tyson

We all have plans to protect ourselves and our families but unfortunately most of us have that plan in our heads or a written plan that is several years old. As we have seen over the past several months, along with the weather related issues in the south over the last several weeks, things happen and disaster is real!

It’s Real … The 2020 global pandemic rocked the world and it’s not over yet. How many people planned for a 3 month shutdown of life? I can’t think of anyone who was ready for that. Insurance companies denied “business interruption” insurance claims and all revenue generating production stopped. The government provided funding to help maintain the work force and cover some expenses but everything else stopped.

Disaster comes in all forms … When we think about a disaster we think about storms, fires and floods but what about all of the other scenarios that can develop. As a business owner everything you depend on has a disaster liability. From the electric to turn on your lights to death or disability, there needs to be a written and updated plan for response. One of the most overlooked and misunderstood disasters is not having a partnership buy/sell agreement.

The Partnership Buy/Sell Agreement … You may become a partner or take one on for a variety of reasons but is there a planned separation agreement? Taking on a partner is like getting married, everything is community property unless outlined by a legally binding agreement. Unforeseen things happen all the time. What if your partner had a car accident that left him/her permanently disabled or worst. Do you want their spouse or estate to be become your new partner? Guess what, unless you have an agreement in place they already are. Now you have to buy out the other side while dealing with, understandably, irrational emotions. You have to buy back your business.

Buying Back Your Business … Transitions are never easy. Money and emotions do not mix well. Predetermined values are essential to formulate a buy/sell agreement. The funding for that agreement should also be securely in place. If you have a business that is valued at $1M, you would need $500k to buy out a partner or an estate. But what about key personnel?

Key Personnel … The ultimate disaster for a business is the death of an owner, principle partner or manager. Replacing that person can be difficult and expensive. A key personnel insurance policies should also be part of a disaster recovery plan. Talk to your legal and insurance advisor for more insight and options.

Disaster Recovery … I can’t tell you how important it is to prepare for that day that you get punched in the face and have to get up quick. You need professional advice and yes, it will cost a little money. 

Money … I am not a legal or financial expert but I did run a fair size company for a lot of years. The best investment you can make as a business owner is quality, industry specific, consultants. Legal, financial, insurance.

October 18, 2020 Posted by | Uncategorized | Leave a comment

The New Concerns for Your Dental Equipment

In the movie Major League Actor James Gammon, who played the team’s gravel-voiced manager Lou Brown explained the game of baseball in simple terms “you hit the ball, you catch the ball, you throw the ball”. Now we all know it is not that simple especially now in the Corona Virus Error but your dental equipment is not that much different. It needs regular maintenance and some TLC. Broken down into “Lou

Brown explained the game of baseball in simple terms “you hit the ball, you catch the ball, you throw the ball”. Now we all know it is not that simple especially now in the Corona Virus Error but your dental equipment is not that much different. It needs regular maintenance and some TLC. Broken down into “Lou Brown” terms it’s all about water and air. In a time when technology is all you hear about we tend to forget the basics, your dental equipment. The mechanicals you need to practice dentistry are often abused and get prematurely old due to lack of maintenance. Think about the “Panic Centers” and service them regularly.

The Panic Centers … The dark places where nobody wants to go. Your air compressor and vacuum system are the keys to your clinical dentistry. They are not the brain of the operation, they are the heart. If either one goes down you can’t do much dentistry and Hygiene is completely shut down. That’s when you panic!

Air Compressor … A dental air compressor is the heart of your practice and is specifically designed to deliver clean dry air. They are complex in design and have filters and purge valves that have to be cleaned annually. Oil-type compressors may need to have oil added or a complete oil change. Oil type compressors are not that common any more due to the oil vapor that that leaves a residue buildup on the walls of the airlines. Most offices take the compressor for granted but think about what you would lose if it went down in the middle of the day. It’s not that expensive (a few hundred dollars) to have a small spare commercial compressor standing by. Look at it like an emergency generator that you picked up at a home store. For the several hours or a day that it takes to get the main system up and running you will still in business.

Vacuum Motors … There are all types of vacuum systems Do you know if you have a  wet or dry pump. Vacuum systems work opposite from compressors; one is positive pressure and the other negative. Compressors turn on & off depending on air pressure but vacuums are high power motors that are designed to run continually for long periods of time. But again, filters, valves and the amalgam separator need to be serviced. Annual maintenance is strongly recommended and scheduling a service call whenever it is time to change the amalgam separator is a great opportunity. However, now we have some new concerns.

The New Concerns … Hypochlorous Acid (HOCl) Cleaner & Disinfectant. Anything with the word “acid” concerns me when there is electric circuitry involved. If you are fogging your office you may be damaging you dental equipment. I am not saying you shouldn’t do it but recognize the potential hazard to hard assets such as X-rays Units, Intraoral Cameras, Computers, Cavitrons, Electric Handpieces, etc. The fog is an acidic vapor that is designed to penetrate anywhere aerosols do. We know that the vapors from  regular disinfectants and wipes leave residue on all the same equipment and will decrease life expectancy so we can only guess what the long term effects of Hypochlorous Acid will be.

Maintenance Program … The easiest and most financially sensible thing to do is to schedule one day once a year to have all of your equipment serviced. In most cases it’s just a 1 to 2 hour service call but as Benjamin Franklin said “an ounce of prevention is worth a pound of cure”. You have practice management software and so does your service tech. put it in the schedule whenever your amalgam separator needs to be changed. Get it all done at the same time and you will prolong the life and function of your equipment. Also, scheduling the time is under your control to avoid any clinical disruptions.

Please feel free to contact me at any time with questions or concerns.

 

August 9, 2020 Posted by | Uncategorized | Leave a comment

Surviving The Dental Health Industry “Learn Advanced Cosmetics!”

The rules have changed for the average dental office in the northeastern part of the country. The advancement of technology in the public sector is introducing the new patient base to high tech dentistry. Millennials are nearing their 40’s and Gen Z is moving into their 20’s. Large offices are advertising on TV and radio, insurance reimbursement rates are dropping, and the cost of doing business is rising in all areas. The U.S. Department of Health confirms that more dentistry is being done today than ever before but where? Question: Why should a patient come to your office and not the one down the street when you both participate with the same insurance?

Why … Did you ever look at your practice through a patient’s eyes? Why would you want to sit in your chair for an exam or procedure. When you go for healthcare what are you looking for. Take relationships out of the equation, they come later, focus on the environment you are in. Think about what the new patient base expects and what you can deliver today, you may just come up short.

What can you offer today … The magic words are “Perception & Cosmetics”. You are a real good dentist (Oral Healthcare Professional), you use top quality materials and stay current on new procedures and techniques but the new patient doesn’t know that. The perception you offer the new patient is the difference between you and the office down the street. Its not hard, its just an approach. Give the patient more than they expect, deliver an environment. Question: How advanced are your cosmetic skills?

Cosmetics … What type of dental practice do you have? Does it gain the most revenue from hygiene, crown & bridge, cosmetics, etc.? With insurance reimbursements trending down those everyday nuts & bolts procedures, if managed correctly, should cover your overhead but they won’t get you the gold ring. Today’s dental practice must provide a wide range of cosmetic options. We see it everyday on TV and hear it on the radio, Clear Aligners, One Day Smile, Smile Direct, etc. Every dental practice should be following the in the wake of this marketing jet stream and have all those same elective offerings available. Every elective procedure is added revenue. Look at every elective procedure as a profit center.

Profit Centers … Most of us do what we do for one of three reasons, Fortune, Glory or the Betterment of Humanity. Fortune is always first and it facilitates the rest. Everything in your practice must be looked at as a profit center. Sometimes there will be a negative but how that negative effects other profit centers may help increase their revenue generating abilities. Hygiene may show a negative but how does it relate to the revenue generated by Cosmetic Dentistry ? The patient believes the hygienist not you.

Cosmetic Dentistry … As a dental professional you learned how to create things. You construct and repair. There is an artistry about what you do and you love it. Elective procedures provide a “creative” opportunity and are usually private pay. That’s where the money is and you can offer money saving options, such as Care Credit, to the patient to help close treatment plans. Do you do clear aligners? There are several excellent options that are less expensive than advertised brands. New materials that give the patient a 3-5 year chairside crown or veneer and implementing facial fillers such as Botox are high profit centers that get patients talking and generate personal referrals.

Serving the Change … You can’t fight change, it is going to happen. It’s happening around us every single day. Separate yourself from the crowd and show off your talent. Please feel free to contact me at any time with any questions or concerns.

 

December 29, 2019 Posted by | Uncategorized | Leave a comment

It’s a Bad Time of Year

Fall back, spring forward is something most of us grew up with. Daylight savings time was just converted back to standard. First established in the late 1800’s it was designed to get more hours of daylight for work. The concept took one hour of daylight and moved it from morning to night. It also has a big effect on people that work on a time slot schedule like in a dental office. Unfortunately, the psychological adjustment also effects the boss.

The Boss … This is when a team leader needs to step-up and show why you are an All Star! That hour will effect you as much as anyone else but unlike your team you have no choice but control your emotions while dealing with theirs’s.  Lead by example and do something special to lighten the environment.

Lighten the Environment … For the next week or so your team will be grumpy. Your patients will be grumpy. Your family will be grumpy. Everything in your life will be “out of it” however, it will get better. But you can’t let your team’s “blahs” add to your patient’s grumpy day. So, carve out an hour and buy them lunch. Smile, be overly up beat to compensate for the time change blues.

Time Change Blues … Daylight Saving Time (DST) messes with our body clock. Changing the clocks does not create extra daylight, but it shifts the time the Sun rises and sets. This can cause disruptions to our body clock, otherwise known as the circadian rhythm. Generally, adjusting to the time change in the spring is more difficult than when the clocks go back one hour in the fall. But losing an hour of sleep may do more than just make you feel groggy — it could have a serious impact on your mood, motor skills, appetite, and even your heart. Understanding the effects of time change is part of employee management and the Total Health Concept.

The Total Health Concept … The key to success if finding the positive that is in every negative and use it for the overall good. Question: What is the positive in a biannual time change? Answer: Asking your patients how they feel…  How many people ask you how you feel with the time change? Nobody… so it is something different that a patient will not expect but remember. Have a conversation about the concept. Ask your team to bring up the subject with the patient and you will see how it helps them to understand that time change effects everyone. You are also creating a small WOW factor because nobody ever spoke to your patients about total health and sleep deprivation.

Sleep Deprivation … Don’t you just love how everything comes full circle? The real positive of the time change conversation is that it opens the discussion of OSA (Obstructive Sleep Apnea). Now you may have a clinical treatment plan that fits and advances you overall marketing plan.

Your Overall Marketing Plan … Everything feeds everything else. Please feel free to contact me at any time with any questions or concerns.

November 3, 2019 Posted by | Uncategorized | Leave a comment

To Build a Dental Practice You Have to be Different!!

Ask yourself this question: Why should a patient come to you and not the office down the street? Your office is modern and updated just like theirs’. You have digital radiography and an intraoral camera just like them. What about patient communication? Do you have what they have? Do you offer as many in-house procedures as they do? Do you offer Pain-Less Dentistry?

Pain-Less … Is just that, less pain so don’t confuse it with painless. If I told you investing $150k would get you a $150k return in the first year and then $150k every year after that for 5 years would you consider the offer?  It would be part of a master marketing plan that allows you to provide services that most dental offices don’t do, YET! Pain-Less means utilizing a STA System (Wand) along with OraVerse or something like a Solea Laser. STA sands for Single Tooth Anesthesia and in only some cases will OraVerse be requested. Onset is immediate and the patient will not feel the injection and I can attest to that personally.  The only downside is that the technique requires a slow injection and a special needle. But, it is a practice builder, especially for new patients. Then there is the Solea Laser. This unit will allow you to do restorative dentistry without any anesthetic. Sounds hard to believe, but I saw it done. I also saw an old amalgam being removed again without anesthetic or patient discomfort. If marketed correctly, this may be a huge part of practice growth and new patients. You do a class II on a patient with no needle and no pain, you have a patient for life and they will tell others. The only downside is that it is expensive but the return on investment could be incredible.

Return On Investment (ROI) … Any new system implemented must be preceded by a marketing plan. Digital Radiography is old news to the Millennials and Gen Z. They are looking for paperless environments and all the bells and whistles that they see in the ER or on the net and they want it now. Sign-in tablets linked to your software, intraoral cameras, transillumination systems, impression scanners, Cone Beam, etc. are all investments in technology that offer a return but where do you go first for the best return? The Biggest bang for your buck? I like Cone Beam Technology as a starter.

Cone Beam Technology … Outside of the dentist the biggest revenue generating thing, pound for pound, in a dental office is a Cone Beam 3D X-ray. Not only do they save time but the diagnostic abilities opens the door for all types of new treatment plans and acceptance increases dramatically. Cone Beam Technology today has brought dentistry to a new “total health” level. Give them more than they expect.

More Than They Expect … It’s time to make your practice different and tell the world why. Practice total health and adjust your marketing to demographics and generations. Baby Boomers are in their restorative time frame and the coming generations will have healthy teeth (because we are so good today at what we do) so unless we focus on promoting cosmetics and total health all we’ll be left with is hygiene. You have to different and the train is leaving the station, jump on now. Please feel free to contact me with any questions or concerns.

 

October 27, 2019 Posted by | Uncategorized | Leave a comment

Looking Ahead—Dentistry 2020! Patient Expectations


In 1964 Bob Dylan wrote the song “The times they are a changing” and they were. They still are, just at a much faster pace and in a lot of different directions. One thing is for certain, change will happen and survival is adapting to the change.

I grew up in the dental industry. My grandfather opened the first dental supply company in New York City. That was around 1912. Back then they filled teeth with gold and amalgam. Dentists would mull the silver and mercury in the palm of their hand. Looking back over the years the changes have been good. Survival in the business of dentistry was easy. You didn’t have to be that smart to make money. Today the world is much different and dentistry is advancing as is the patient’s expectations.

Patient Expectations … Nobody likes going to the dentists and today’s average patient expects personalized treatment that is fast and painless. The faster you get a patient out of the chair, the better dentist you are in the patient’s eyes. Recently there have been commercials on TV advertising dental groups. The adds feature 3D imaging and same day dentistry. The adds are targeted at all demographics, Baby Boomers, Millennial, and Gen Z. Your future success in dentistry will be directly effected by a patient demo-graphic and Gen Z is turning 25 years old this year. Question: Who is you patient base over the next 10 years? Communication with your base will require an investment in technology.

Technology amazes the masses … 50 years ago the world stood still when we walked on the Moon. Today we pay little attention to the men orbiting the earth in the international space station. We expect technology to help get us through everyday so what is the wow factor when visiting the dentist? Let’s start with the reception area and a big flat screen monitor.

Reception … Video is a must. The big screen on the wall will allow you to compete with the cell phone and magazines. That monitor should be showing a dental theme featuring cosmetics and facial design. Advertise your services to promote other technologies the patient will see in the clinical setting. Now add a cell phone charging station and free WiFi (note: make sure that the WiFi is completely independent form your office based network) and your patient will feel comfortable.. Your patient check-in should be utilizing a tablet or iPad that directly updates your records. People don’t write on paper anymore. All of this happens before the clinical experience.

The Clinical Experience … Break your patient’s visit into thirds. MLB Hall of Fame Manager, Tommy Lasorda, once said that during a season you will win at least one third of your games and you will lose one third of your games, it’s the middle third that makes or breaks. The clinical experience is the middle third. Sitting in a dental chair is a very uncom-fortable situation. Dental procedures are traumatic events for patients. Communication is the most important thing, but not just with words. You need pictures!! Digital imaging is essential for patient communication and treatment planning. 3D imaging, intraoral cameras and impression scanners are tools designed to help diagnosis and explain your treatment plan. Technology is what the quality patient is expecting.

Quality Patients … The most important fuel for your dental practice is a quality patient base. Quality is defined as compliance in maintaining their oral health and routine office visits. Insurance based patients are usually more compliant but now there is a the low reimbursement rate that you need to be manage correctly to maximize the ROI (individual patient value). Question: Why should a patient come to your office instead of going down the street? Please feel free to contact me with any questions or concerns.

August 25, 2019 Posted by | Uncategorized | Leave a comment

Vacation Notice & Contact List

Please be advised that I will not be available the week of July 22nd and will be returning to the field on July 29th. I will not have the ability to return calls but will do the best I can to respond to emergencies. For immediate attention, please contact my team and refer to the below contact information. I will follow up on all situations that arise.

Merchandise orders:

In-bound customer service …… 800-372-4346

Andrea Silberberg ……………. 800-707-5678 ext. 2228878

Robin Reeman ………………… 631-454-3168

Metro Branch, Moonachie, NJ ………… 201-440-7004

Equipment Field Service ……………… 800-645-6594 prompt #3

Equipment Replacement (New)

Eric Green ……………………. 862-812-0426

Cliff Brenner …………………. 516-655-4322

High Tech Equipment & Computers

Matt Chernego (New) …………551-697-1596

Tech Central (Service) …………887-483-0382

July 17, 2019 Posted by | Uncategorized | Leave a comment

The Dental Business Institute – Prepare for the Future

The best way to be successful is to listen and observe the success that others have had or are having. There is no cookie-cutter solution because every business is different and serves a different demographic (that’s why I like local consultants) but best practices can be modified to fit any environment. A dental practice is a small business and it has to run efficiently while investing in growth. Years back I attended the Disney Institute, the seminars and training changed the way I approached customer service and employee management. Employee management (Team Engagement) is the foundation for success. The Dental Business Institute ((https://henryscheindbi.com/) is a similar program that was specifically designed for the dental industry by Henry Schein.

Many dentists who operate independent practices find it difficult to compete in the ever-changing marketplace. Many small group practices encounter the same challenges. Reduced reimbursements and emergence of group and corporate practices force practitioners to think about the future differently. The Dental Business  Institute at Henry Schein was created to support and guide dentists through a successful entrepreneurial exploration of their business and its potential.

The Dental Business Institute … is a year-long educational program that guides practitioners through the process of applying different business models to their practice vision. Attendees first identify their desired outcome, then design a business model that helps achieve that outcome. The model is tested through simulation to see how different decisions impact financial statements and attainment of business goals.

Program attendees can experience the impact of business decisions prior to investing time and resources. As plans are made, each action is tested to determine the impact on cash flow, profitability, and valuation. Based on the simulation results, participants learn where to adjust prior to implementation in the real world.

Question … What is the most important asset you have? It’s probably the one you abuse the most.

Answer … Your Team! Most dentists (small business owners) don’t understand how to develop strong clinical and management teams that will work together “peacefully”.

Success Costs Money … It is true that you need to spend money to make money. Where you spend (invest) your money will effect the success of your business. A competitive compensation package will attract competent team members and retain them for a long time. Today’s labor shortage puts quality at a premium and if you pay peanuts you’ll get monkeys. You can’t build a dental practice that will rise smoothly through the next decade without a solid foundation. Listen and learn from experts. Please feel free to contact me at any time with any questions or concerns.

May 22, 2019 Posted by | Uncategorized | Leave a comment

Walking Over Dollar$ -To Pick Up Dimes!

“In the business world, the rearview mirror is always clearer than the windshield”

Warren Buffet

Price, Price, Price is a consumer mentality. Sure, at home I cut coupons and my wife looks at all the specials but we are doing it in our free time not in time spent generating positive revenue. I owned and managed a dental distribution company for a lot of years and our goal was to buy low, sell high and generate profit. However, with the materials we used to operate our business we cut a deal, reviewed it annually and never looked back. It was all about production, moving product and turn-ing inventory. We utilized analytics to know what was selling, where we were making money and where we were spending it. Today, the analytics available is so much more detailed but the data has to be there to analyze.

Analytics … Every industry utilizes analytics to refine their production and gain a competitive edge, dentistry is not different. We hear about it most in sports and Amazon & Google have been front page news with everything they know about us. Isn’t time to use this technology in analyzing production, purchasing, team engagement, patient treatment plan acceptance and re-care? This can be game changing for the dental practice looking to grow. By utilizing today’s technology we can capture data and use it to positively effect the bottom line

The Bottom Line … Making money is the bottom line of every business. Clinical perfection is always at the top of the list, but face it, making money is what we get up for in the morning. Fortune & Glory, but fortune always comes first. Unfortunately most dental practices are also small businesses and often general consumer concepts override good business practices. We tend to focus on the individual line items more often than the whole picture. Time is the most valuable thing you have and getting more production out of a fixed component is “Best Practices”

Best Practices … What exactly does that mean? It’s a standard of universal business operations in a perfect world. We all know that nothing is perfect but we do need standards to use as a goal. One of the parts of best practices that is often overlooked is time spent.

Time Spent … Chair time is always a concern for dental practices. Manufacturers design products to speed-up clinical procedures to allow more time to see more patients. If done correctly and systematically 1 to 2 more patients can be fit into the schedule and that is added revenue. Time spent may be the most valuable variable investment any business has. Time spent should be focused on revenue generating projects and procedures weather it be chair side or patient contact. Time spent on non revenue generating business necessities such as cleaning & product procurement has to be minimized by product selection and automation.

Automation … Yes, it may cost a few dollars but way it against the cost of time spent and increased revenue. It’s all about the bottom line. If $10.00 spent over there allows time to generate $25.00 over here, it’s a win! Those of us in business that worry more about spending the $10.00, are Walking over Dollars to Pick up Dimes. Please feel free to contact me with any questions or concerns.

May 4, 2019 Posted by | Uncategorized | Leave a comment