Cliff's Notes

The Business of Dentistry

My Feet Hurt! But I’ve Been Sitting all Day? “Dental Office Ergonomics”

It’s 3:00 in the afternoon and your feet and back are starting to hurt, your neck is stiff, and you’re getting a headache. Maybe it’s the stress of running a dental practice or maybe time to look at your working environment as the cause. My advice to my clients is simple, you can try to save money in a lot of places but there are three where price should not matter, your handpiece, your stool, and your overhead light.

Your Handpiece … A craftsman does their best work with the best tools. Your handpiece is your #1 tool. You use it on almost every patient and there is a difference between a $200.00 and a $1200.00 handpiece. Yes, quality handpieces are expensive but so is your time. Quality preforms better and in the long run will cost less but the big advantage is a smooth cut and lower noise. It’s the noise that effects your health. The highspeed squeal is only inches from your ear. We are talking about hearing loss and it is a real problem in dentistry.

Your Stool … This may have been the most misunderstood piece of equipment of the last generation. Back problems, leg problems, foot and neck issues can all be attributed to your stool and positioning. You know who doesn’t have any of these problems? The dentist that works standing up. So, if standing is not an option then you need to look into quality seating and learn about “positioning”. Todays operatory seating is designed to compliment the new patient chairs. The patient’s head position can be adjusted to fit the dentist’s posture when seated correctly in a quality stool. You need to bring the patient to you, not adjust yourself for the patient.

Your Overhead Lighting … This is about your eyes. LED Lighting is the best and there is no excuse not to upgrade your current light to LED with a simple adapter. Your counter tops should be well lit with the same type of light (LED) so eye strain is minimized when looking away from the oral cavity. The focusing and adjusting your eyes have to do during the day will lead to eye muscle fatigue. Got a head ache?

The 80/20 Rule … I can tell you that eight out of ten dentists and hygienists complain to me about aches and pains but they don’t do anything about it. OMG! It’s going to cost some money to make you feel better. So, let’s talk about the cost and you can think about it while your driving home in your $40,000.00 car…..

1) Your Handpiece (air driven) $800.00-$1200.00(depending on brand)

2) Your stool (Drs.) $400.00-$1200.00 … (Asst.) $600.00-$1200.00

3) Overhead light conversion Halogen to LED $350.00 (most brands)

Ask your friends about their chairside health. This is about you and your team and your working environment. A healthy and happy team improves production. A work environment and flow evaluation can be arranged free of charge but to fix any problem you will need to invest in your health. Please feel free to contact me with any questions or concerns.



August 13, 2017 Posted by | Uncategorized | Leave a comment


We all know that the internet is a dangerous place. We employee security com-panies and utilizes encrypted data. Unfortunately the consumer mentality that has been bred into us since childhood tends to take over. The world of commerce has changed dramatically over just the past 3 years. Amazon, Wayfair, Walmart and other are competing for your dollars by offering a good price and convenience, but a healthcare provider needs to understand the “unseen” dangers in the unregulated internet.

The UnRegulated Internet … Healthcare providers are regulated by state and federal agencies, therefore, everything they do is subject to interpretation. What would happen if a procedure fails and the result is litigation? Was the failure due to an inadequate clinical procedure or was it due to product failure? Your defense team will blame the material manufacturer but their defense team will want to know where and when the materials were purchased. If the materials used were not obtained from an authorized U.S. distributer, you are on your own. The original manufacturer will not support your defense. Now you need to prove that the materials used during the clinical procedure were acceptable for use, that they were not counterfeit.

Counterfeit Dental Materials … If something sounds too good to be true, it usually isn’t. In today’s world market there is a counterfeit everything and dental materials are no different. Companies like 3M, Dentsply/Sirona, Kerr Sybron pursue and litigate unauthorized distribution internationally on a regular basis. You can receive updates and information on grey market and counterfeit issues as well as authorized distributors by calling the manufacturers directly.

Authorized Distribution Channels … There is a reason that only certain companies are authorized to distribute a manufactures products. The requirements are based on the product line and inventory storage capability. An authorized distributor must have inventory rotation systems and be able to purchase a large opening order covering the manufacturers entire product line. As an example, Dentsply Sirona has about 35 authorized dental distributors in the US and one, locally, is under a federal indictment due to a Dentsply investigation into the handling of there product. However, a quality distributor will have some requirements from the manufacturer, and that is product liability.

Product Liability … You automatically think that product liability is the manufacturer’s problem, that is a consumer mentality. In the eyes of the law your patient is the ultimate consumer and you are responsible for the products you use and the source of supply. If the product in question was not obtained from an authorized distributor, the manufacturer’s insurance company will claim no liability and you will be between a rock and a hard place.

Liability Insurance … Your malpractice insurance covers you to the extent of the policy but what about the source of your payables? Do you have liability insurance conformation from your I.T. Company, electrician, plumber, dental supply, lab, etc? Henry Schein, like most regulatory compliant companies, requires proof of product liability before they will release a product into the market from any distribution center. This should be part of your risk management program.

Risk Management … There is so much you don’t know. Your concentration is on patient care and treatment planning and you have insurance backing you up incase of litigation. However, there is a good chance that you are setup to loose. Record keeping is the #1 defensive strategy and it is so much more than accurate charts. You don’t know what you don’t know. From product liability to patient communication to employee management and sales tax liability, it’s your responsibility.

August 7, 2017 Posted by | Uncategorized | Leave a comment

Office Culture? What’s That?

Your business culture is so important to your success that it will break you if not controlled and directed from the top. As most of my clients know I am a big fan of the Disney culture. I read their blog and have attended a program on Team Management that was offered by the “Disney Institute”. When I joined Henry Schein eleven years ago I was impressed at the way they had developed a similar culture and emphasized the team approach. The Disney Institute is a real place in the Magic Kingdom, but it is not for kids. You have a vision of what you want and now you have to learn how to energize your team and get them to believe.

Believe in the Dream … Leadership is getting your team to understand your vision and adopt it as theirs. Leadership is getting people to do what they don’t want to do (work) and enjoy doing it. All of my clients have a vision and they all follow their dreams in different ways, but how you speak to your team on a daily basis will define the organizations culture. Where most leaders fail is when they forget how to encourage and your patients sense it.

Encourage don’t Discourage … People are different and their personalities will effect their job performance. Understanding personalities and focusing on the positives is essential for a quality business culture. Encourage the positives, train the negatives and keep an open door to suggestions and ideas, manage by walking around.

Management by Walking Around (MWA) … The phrase was created by IBM back in the 1980’s. The concept was based on the idea that a department manager would get up from their desk and walk around the department so they could interact with their team and develop a winning culture. Disney changed the phrase to “Management by Wandering Around” because when you wander you are relaxed and approachable. At the time I attended the institute’s program I owned a small company that employed around 45 people. The first day back I tried the Disney version of MWA and was amazed at the instant results. My team entire team responded in a very positive way and an enhanced team work culture began to develop. Throughout my career I have seen all types of business owners. Some are respected and some are feared. The real culture killer that will hurt your business and breeds discontent is a strict regiment and fear.

The Regiment … I believe that people get up in the morning for one of three reasons, fortune, glory, or the betterment of humanity. For most of us, fortune comes first. Your team members show up every morning because they need to support their lives. Your office is not where they want to be, it is where they have to be so management has to develop a culture of growth, advancement and achievement. Your team needs direction and continuity or you will have team turnover and that puts the breaks on any organization. In a recent email I saw, a manager use the word “punish”, wrong, wrong, wrong. By “cracking a whip” you are not fostering the vision. You need a blend of empathy and accountability.

The Vision … It is hard to develop, implement, and travel the path through your career. The first question to ask yourself (being realistic) is what exactly do you want. I asked that question to a young dentist after a practice acquisition. The answer was “I want it all, the houses, cars and boats, how do I get there?” I like to think that my job is to help my clients chart their path so their dreams come true. Please feel free to contact me with any questions or concerns.

July 24, 2017 Posted by | Uncategorized | Leave a comment

Is Your Consultant a “Dutch Uncle”? Do You Have One?

  I know it may not sound politically correct, but it is a term of endearment and love. My dad used to say to me “let me talk to you like a Dutch Uncle and tell you what you don’t want to hear”.

A quality dental business consultant tells their clients where their weak points are. It’s not being just another yes man or woman.

The Yes People … All is good in the world when you hear from a consultant what you want to hear, it’s human nature. However, what if your trusted consults always agreed with you? Think about it, did they ever bring up negative situations that you were not aware of? Have they criticized any of your systems, procedures and protocols? What do they cost you in real time? Or are you lucky and have a Dutch Uncle?

A Dutch Uncle … It is politically correct, it is a term of endearment. My dad was my 1st Dutch Uncle. He always told me what I was doing wrong and why. It’s the “why” that makes it good. Throughout your career you may have several confidants specializing in different areas of your business and life. You don’t know everything and if you think you do your just fooling yourself. The most successful people listen and seek information. As one of our great past president said “When I am not an expert on something and don’t know what I don’t know, I ask the people who do and I listen”. When I hear a dentist client is taking advise from another dentist it’s time for me to become the Dutch Uncle, what works for someone else most probably won’t work for you. Consulting with other dentists on clinical procedures and treatment planning is a good thing because that it what they do everyday, but every dental practice (business) is different and a good professional will customize the management.

Customized Management … The very first question any quality consultant should ask is “what do you want”. That is not asking what do you want me to help you with, it’s asking “what do you want your life to look like”. Then all future plans are built around that vision. I have had the fortune to meet and associate with a lot of very smart people. I have learned a lot and continue to. Professional guidance in running a business is essential for success especially in today’s competitive market. As a business owner you do not have time to reinvent the wheel, the systems are there but you need to invest some time and money to put them in place. You were trained in clinical dentistry and not business management. You can’t survive if you think like a general consumer.

A General Consumer … Once again I will go to the 80/20 rule. 80% of the dental professionals I work with run their business like they run their home, as a general consumer. The remaining 20% develop very successful practices that address the competitive market in all areas of the organization because they listen to “experienced” professional consultants.

Professional Dental Practice Consultants … There are so many to choose from. All claim to be the best and they all teach you how to dot the “I’s” and cross the “T’s” but each has it unique method in establishing the business culture. Culture is so important when dealing with patients and especially team members. There are offices I walk into that you can feel the tension. We’ll discus culture in the next issue of Cliff’s Notes.

July 18, 2017 Posted by | Uncategorized | Leave a comment

O.S.H.A. / HIPAA … It’s A Lot More Than Just Training!

You did your due diligence and the entire team has received their annual updated on OSHA & HIPAA and all is good in the world. Or is it?

Most dental offices that I walk into are not in compliance with federal regulations that are required by law. Sure, most have had OSHA updates for the team, but what about the facility? What about software? What about sign-in sheets?

Sign-In Sheets … I can’t tell you how many offices still use sign-in sheets. If you are exposing a patient’s first and last name in a public forum, you are in violation. If a patient’s information or name is visible on a chart or computer screen, you are in violation. These things are easy to fix but the biggest concern today may be your software.

Software … If you are using any of the popular email servers such as AOL or Yahoo, you may be in violation by not having your data encrypted. A number of specialty practices now supply encrypted portals for their referring offices to use. The recent outbreak in cyber invasion has put software and on-line security on the front page. This is an area that a dental office needs professional support and your brother-in-law’s 2nd cousin is not the answer. You need certified a IT group with a lot of resources. Your software security also needs to address your emails so you comply with the HIPAA Omnibus Rule.

The HIPAA Omnibus Rule … This requirement was an amendment to existing HIPAA regulations. It was added several years ago but not many dental offices adhere to it, know about it, or understand it. To sum it up, you are responsible for your patient’s personal information throughout the entire treatment process. You are required to insure HIPAA compliance form every professional or organization that comes in contact with the treatment plan. Specialists, labs, and insurance companies are all part of the part of the healthcare chain and you have a shared responsibility should any of their systems be breached. Your HIPAA liability is on the patient side of your business and the employee side is OSHA compliance.

OSHA Compliance … I have not found one dental office that is 100% OSHA compliant. Although it is almost impossible to fully comply, many of my clients don’t put forward enough effort to look good. OK, your team is trained but what about the facility? Do you have MSD sheets available at a moments notice? Do you have a chemical inventory list? Are all of your product labels filled out and correctly displayed? OSHA inspections can be requested by anyone. In dentistry the most common complaint comes from former employees and OSHA is obligated to investigate. The inspectors tend to understand the nature of the complaint and as long as you showing effort to comply they will work with you. However, if you are overly relaxed about compliance the fines can be big. The best defense is to have a complete office inspection along with team training. For an office inspection, free of charge, please contact me at any time.

July 9, 2017 Posted by | Uncategorized | Leave a comment

OMG! They Charge for Everything!

Yes they do and anyone that tells you different is either misleading you or is just wrong. It’s true that when you begin using an impression scanner you eliminate 90% of the costs of the materials and accessories but there are other expenses that kick in after the warranty period. Annual software support is the new “consumable” product and you need it!

Consumable Product … What exactly are consumable products? They are the things you use that need to be replaced. Prophy paste and impression materials are consumable products. Your handpiece is not, however, the replacement turbine is. When U.S. Defense contractors sell planes and tanks to the government, it’s the parts contract that yields the profits. Over a span of 10 years where have your individual patients spent the most chair time? Maybe hygiene? Hygiene is an on going consumable product. What’s happening in dentistry is that consumable clinical product is being replaced with technology. But, every action has an equal or opposite reaction.

The Reaction … Sticker shock is never fun. Unfortunately, most consumers don’t look at the whole picture when purchasing equipment or technology. They look at the sticker price and not the operational costs. Most new clinical technology requires technical support. After the warranty period there are annual contracts that provide on-line monitoring and live log-in assistance, these services are needed and have to be budgeted as on going operational expenses. The new technology and necessary software will reduce the amount of clinical materials you need to invest in, but it will not save you money (equal reaction) but it will allow you, if used correctly, to be more productive in all of your profit centers

The Profit Center … Have you recognized your profit centers? Do you understand your profit centers? Within any business there are multiple areas of revenue transfer.. Some those areas produce negative revenue but they help off-set their own operating costs by enabling other areas of positive revenue to be more productive. A marketing department is a perfect example. Although there will almost always be negative revenue, marketing can increase patient flow thus increasing production and revenue. So, how can the cost of annual software support add to your profit centers? It can’t, unless you engage the entire wheel.

The Wheel … Running a dental practice (health care business) is not easy. Every department within the organization needs to produce positive results and communicate seamlessly with the other departments. The front desk needs to have smooth communication with clinical, financial, and marketing departments. In some offices one person may be responsible for several departments making software and technical support critical in juggling everything effectively. In a large office where several team members are involved communication is even more important as is security. Consider your support as part of your insurance risk management program.

Risk Management … Protecting yourself and your business is a top priority. Take a look at the things that will shut you down and cause financial and emotional stress. These areas need to be protected and supported. What is your disaster recovery plan? Prevention should be part of it and technical support contracts are part of that.. It is all part of running a successful business in the 21st century.

June 20, 2017 Posted by | Uncategorized | Leave a comment

Contact Information

Please be advised. Due to family situation I will not be available for the next several days and will have limited access to my voice mail and email, however I will be checking in as often as possible. Please note the contact information below that can assist you in my absence. I should be available after Wednesday June 7th and can adjust any pricing or issues at that time. Thank you for your understanding.


Andrea Silberberg        1-800-707-5678 … prompt #1 … ext. 222-8858

Robin Reeman             1-631-454-3168

Equipment service                   1-800-645-6594

Emergency Equipment replacement … Dean Henry                 908-577-0484

Network or Technology issues … John Giarraputo           1-914-907-9665

June 1, 2017 Posted by | Uncategorized | Leave a comment

The Next Level -Your Dental Equipment & Your Desktop?

The technology train is going faster everyday so if you have not engaged with any of the new technology, it is a long road. You need to start walking down the field or plan on walking off. The next level is here.

As the advancements in technologies reach the dental industry, industry standards will need to change. One thing that will never change is the rising cost of “Down-Time” and the dramatic effect it can have on the dental office.

Down-Time … You have a full day booked or maybe just a few patients and the compressor won’t start. You call your favorite service tech and it takes them an hour to get there. Then they diagnose and hopefully fix the situation, but you had to reschedule the patients and lost the day. What did the down-time cost? What is it worth to never have that problem, because you know it’s going to happen at the worst time. Equipment manufacturers are addressing those concerns.

Equipment Manufacturers … Several of the large equipment manufacturers are incorporating software management into their products. Your compressor, vacuum, x-ray, sterilizer, and more will be monitored and warn you of needed maintenance and possible failure. Just like the warning lights on the dashboard of your car, by addressing the problem before it happens lets you control the down-time. When shopping new equipment it would be a good idea to add this to your list of questions.

The List of Questions … When shopping for new equipment in today’s dental market there are more things to think about than ever before. Everything you buy today must be able to adapt to tomorrows technologies. We have all heard the term open platform, the concept becomes more important every day. Think about the next 5 years and what you will need to incorporate new medicine. One thing that is always overlooked by most dental practices is the cost of operation after the warranty and promotional offers. The cost of software management and support need to be part of your annual budget. Just like your rent it will always be there and continually rise. The success of your practice will rely on the future integration of technology and your dental equipment so plan for the next level. It also matters where the equipment is purchased? Will that organization be able to service your needs in 5 years?

The Next Level … It all starts with quality practice management software. Add to that a quality office manager, not just a front desk, that becomes the systems monitor. If any of your equipment starts to malfunction or is due for servicing, warning windows will appear on designated screens. The data can also be transmitted to a quality service organization so that the technician knows what the problem is and is prepared with necessary parts. The next part of the equation is the IT person. This one is critical because dental related software is very complex. The guy at the gym is not a seasoned dental certified IT group. How about the next level of systems monitoring? It’s here, Tech Central can already monitor your network and provide 24 hour remote service. Soon they will be able to keep an eye on you compressor, vacuum, x-ray, and anything else that gets plugged in. That is where “Out-Sourcing” can save you a lot of money. I have a client that will do $1M Gross this year with 2 chairs. The office spends their time doing dentistry and not paperwork. This is all Next Level Dentistry. Control the costs of operation and spend time doing dentistry. I am always available to address your questions or concerns.


May 28, 2017 Posted by | Uncategorized | Leave a comment

The Audit … Get Ready Because It’s Coming!

Federal Tax Audits, State Tax Audits, Insurance Company Audits

Yes, they are all coming and they will be in real time. With changes in federal regulations and the Affordable Care Act more freedom is being given to the states to manage their own programs. With that, the government‘s plan to lower the federal tax rates will also lead to a reduction in federal aid to the states. The idea is to give the general population more money to spend and a greater say in how they spend it. That is a consumer driven economy. However, to maintain public services the federal and state governments will need capture lost revenue. With the technology now available, and years of electronic data random audits will be the new normal.

Lost Revenue … Hundreds of millions of dollars in uncollected sales tax revenue is lost through interstate retail commerce. Individual state laws do not apply to non-resident companies, states cannot force other states to comply with their laws, that’s where the feds come in. One of the responsibilities of the federal government is to regulate trade between the states. The lost revenue issue may be solved by creating a federal sales tax.

The Federal Tax Audit … Don’t think you are too small to be noticed. The feds understand investment so their time was spent on big organizations. Technology has redefined the term “BIG”. If your organization accepts payments through federal programs such as Medicare, you are on the radar screen. If patients claim your services as tax deductions you’re on the radar. If your cash deposits fluctuate beyond an average range you’re on the radar. Maybe it’s time for a self audit on record keeping, ask your tax advisor.

The Random State Audit … If you have never been through one, you can’t understand. I live in New jersey so I can’t comment on the other 49 states but I went through a NJ State audit and I got to tell you, it is not fun. One of my clients is dealing with it now so I thought it would be a good idea to spread the word of caution. The state asks to see everything and when you give them everything you have, they will ask for more. That’s when the fun starts, finding what you don’t have. You will need to prove every payable and receivable transaction. Everything needs to balance with back-up documentation and if you don’t have it, you pay. State tax laws are very specific and the local governments want every tax dollar due to them. However, taxable items in one state may not be taxable in another. As an example, NJ & NY classify taxable items completely different and the point you take possession is where the tax is collected. Ask your tax advisor about state tax compliance and reporting taxes not collected in both your receivable and payable departments. A $17.00 mistake cost my company $2500.00 in interest and penalties plus the accounting time.

Insurance Company Audits … If you do not participate with any insurance companies this will not effect you. However, if you do participate you are required to prove full regulatory compliance upon request. From OSHA to emergency medical equipment all state and federal regulation must be in place. It amazes me that so many dental offices don’t have an emergency O2 tank with an Ambubag and those that do haven’t checked the tank since they got it. You may want to review your insurance contracts for more details.

The Bottom Line … Benjamin Franklin said “a stich in time saves 9”. Preparation and accurate records are essential. Please feel free to contact me with any questions or concerns.


May 16, 2017 Posted by | Uncategorized | Leave a comment

Doing Things Right or Doing the Right Thing?

    From the Disney’s Talking Points .. Doing Things Right or Doing the Right Thing?       

Picture yourself staying at a Disney resort. You’ve just completed your weeklong stay and are checking out at the front desk, when the Cast Member looks you in the eye and says with a smile, “Thank you for being our Guest this week.” How does hearing the word, “Guest,” make you feel? Since the opening of Disneyland in 1955, Cast Members at Disney theme parks and resorts have referred to our visitors as Guests. Does it matter?

Although using the word Guest is not necessarily unique to our organization today, there are important reasons behind why we encourage our Cast Members to do so. It provides a framework for understanding how we should interact with people – actually treating our visitors as if they are guests in our own homes.

As we have previously shared in our book, Be Our Guest: “…words create images and corresponding assumptions in people’s minds. Take the word Guest. An unhappy Guest and an unhappy consumer create two very different images in an employee’s mind. Guests are welcome visitors, whom you host; consumers are statistics. If someone is your Guest, don’t you feel a greater obligation to ensure his or her happiness?” And, at Disney, happiness is the goal!

In fact, everything we do in terms of service design revolves around our guests and our common purpose—a simple statement that represents what we stand for and why we exist as an organization. This statement defines the expectations we have of ourselves as Cast Members and reads like this: “We create happiness by providing the finest in entertainment for people of all ages, everywhere.” Striving to create happiness allows us to begin forging life-long relationships with our Guests.

So, how can an organization ensure that its employees are able to actually deliver on the purpose? We now return to the question at the opening, “How does hearing the word, ‘Guest,’ make you feel?” You would probably agree that, in general, the words alone are not sufficient. The behaviors – the eye contact and sincere smile – also matter a great deal. In other words, we should consider our focus on “doing things right,” and “doing the right thing.”

“Doing-Things-Right” This is critical for efficient, high-quality, and consistent delivery of the desired Guest experience. One method commonly used is providing scripts. By scripting transactions, you can help to ensure that employees have the tools to “do things right.”

“Doing the Right Thing” On the other hand, providing a clear framework can help employees “do the right thing” on behalf of their Guests, rather than abdicate to the script alone or simply do what’s been done before. This unscripted approach empowers people to internalize and “own” the common purpose and then deliver the Guest-focused behaviors that bring that purpose to life. In past Talking Point posts, we’ve shared that the key to our success lies in a holistic approach. You must give people purpose, not just rules. Once employees understand and internalize the common purpose, they can choose to go that extra mile because they have a heart for service, turning “customer service” into “Guest service.”

Think about it: Are your employees able to “do the right thing” on behalf of your customers, or must they focus solely on “doing things right?”

May 7, 2017 Posted by | Uncategorized | Leave a comment