Cliff's Notes

The Business of Dentistry

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

How to Buy a Dental Impression Scanner

The truth is that dental impression scanners will become standard office equipment just like curing lights and digital radiography. They are a game changing addition to any dental practice. Not just because they are incredibly accurate and fast but also because they WOW the patient. Scanners won’t save you money but they will improve you clinically and increase your production. Unfortunately, not all scanners are the same and what works for your friend may not work for you. Due diligence and team involvement will give you the greatest ROI. Now let’s think about who your current and future patient base really is?

Who? … The millennial generation is you patient base for the next 30 years and generation Z (born after 1996) is coming up fast. These new patients will have dental insurance and expect everything now. Their society wants immediate results, they do not want to wait and they respect technology. A scanner is a WOW factor that can reduce chair time by 15-20 minutes for both C&B appointments (prep & seating) and with a mill 70-90 minutes and you are done (bill upon insertion). So if you haven’t started thinking about digital scanning you better or you will fall to far behind the healthcare curve and playing catch-up is more expensive. Where will you & dentistry be in 10 years when x-rays will be a thing of the past?

How? … The very first thing you have to decide is how far do you want to go with digital scanning. Do you plan on doing in-office milling anytime in the next five years? If you will be practicing for more than another 10 years you should anticipate it. There are several very good scanners on the market today and they are all in the same price range. Price is the most attractive part to most dentists but the least important. Service and support is the major concern when incorporating advanced technology along with training and the expected learning curve. There is an old saying “price, quality or service, pick two because you can’t have all three. When it comes to technology integration, always pick quality & service. Sales people are very good at what they do and will tell you that their technology works with yours. Consider speaking with experts that are authorized resellers for more than three different brands so you can get a non-biased comparison. The reseller should also have service technician on staff that can work directly with the manufactures technician. Don’t get caught in the technology sandwich when both sides of a problem blame each other.  So, what is the next step in due diligence?

What? … After you decide to start looking into digital scanning you need to have an IT group that is certified in dental technology evaluate your network to see if it needs to be upgraded. Often practices purchase technology and realize after the fact that they need to invest in additional hardware or software. Have all demonstration done in your office with your team present, make them part of the experience. Getting the team excited will help with the introduction to patients and minimize the learning curve. Again, make sure that your IT group is fully trained on all the technology that is running through your network. We tend to trust our mechanics and often they don’t have access to manufacturer support, that’s when everyone is blaming the other one and your stuck in the middle (the sandwich). Seek out organizations that represent several brands, have their own IT and support systems and can own your  down time.

Conclusion … Don’t buy something because your friend did, few admit to a $25k mistake. Please feel free to contact me at any time with any questions or concerns.

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

Dental Operatory Equipment “In The Long Run”

Dental operatory equipment is very expensive and understanding what causes breakdowns is an important part of maintenance and work flow. The task of maintaining working assets in a dental office is usually entrusted to a team member (Dental Assistant) and never thought of again until something breaks. But, what caused the down time and can it be avoided in the future? Proper maintenance will cost a few dollars but will dramatically increase the life span. It starts with quality.

Quality Lasts … I have been in the dental industry all of my life and I have seen so much come and go but quality lasts. Today I still see 30 year old Midwest Quiet Air handpieces still in operation. 25 year old Adec Mini-Troll delivery systems & Belmont 071-A X-rays are still working everyday. Why is a $5000.00 chair better than a $3500.00 chair? It’s quality and life expectancy. So, what can be done to maximize your investment? Disinfectants can be a big part of the problem.

Disinfectants … Infection control protocol requires all operatory equipment be cleaned and disinfected after each patient. The chemicals used in the sprays and wipes are made to kill things and are not kind to plastic, metal, circuitry and upholstery. Did you ever notice a yellowing effect on your equipment? Disinfectants need to dry on a surface to be effective and the vapor in the air settles on everything. After repeated use these chemicals will reduce the life expectancy of all equipment especially lower quality items. You can’t prevent it but you can maximize the time line.

Chairs & Stools … Every dental chair manufacture recommends that nothing but soap and water be used to clean patient chairs and stools immediately after use.. That’s not practical because of the time it would take to turn over a room. Sprays and wipes are used to for faster turn around, but the chemicals involved will deteriorate the equipment over time. There are several products on the market that now address the issue of upholstery and plastics yellowing such as Optimum 33TB by Sican or CaviWipes1 by Kavo Kerr. However, barriers are the best. There are barriers for everything but Cover Film should be used every where. Use cover film on the chair switches to protect liquids and vapers to settle on circuitry. Use a full chair cover (my favorite is Slip-N-Grip by Kavo Kerr) to prevent excessive ware, especially when the weather is bad. And at the end of the day clean the upholstery with soap & water or even better, Chair-Guard by Palmero Sales. Chair-Guard will protect the upholstery against disinfectants but it has to be used everyday and it does have an odder so end of the day use is recommended.

Delivery Systems … Internal and external maintenance is required if you want to protect the tubes, valves and blocks from corrosive agents. If you choose to use wipes, the same ones used on chairs and counters will work but lower quality plastics may yellow. Internally you should be using inline biofilm filters and utilizing a handpiece purge. Handpieces have drive air & exhaust lines. Excess lubricant will expel through the exhaust and build up on the inside of the tubing that will lead to replacement. An external system will reduce the vapor and also increase the life of the handpiece. All handpieces should be removed from the room before clean-up. Please feel free to contact me with any questions or concerns.

 

 

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

Infection Control, Not Good …

Over the last several months the local news has been covering the lack of infection control at several large health care facilities. One resulting in numerous deaths and the others just now getting investigated. Being as infection control is one of my strong points let’s do a quick review.

History … Boring to most but we learn from it. The first infection control seminar I produced featured Dr. Robert Runnels from the University of Utah. Dr. Runnels was the developer of the Chemclave, a chemical vapor sterilizer. Without a doubt it was the best form of sterilization available to dentistry but not practical. Dr. Runnels spoke about the need to continually improve your infection control protocol because bacteria and viruses continue to evolve. Today we are fighting things that didn’t exist when Dr. Runnels spoke 30 years ago..

They Didn’t Exist … Politics aside, people, animals and plants can move globally with more ease than in anytime in history. The recent outbreak of measles in New Jersey was spawned by a visit to Israel. A flu outbreak in New York City can easily start a pandemic after a jumbo jet plane ride to London or Paris. Medical science is at constant war but now we have super bugs. Up graded protocol is needed. Lets look at what most offices do and what they should. You don’t know what you don’t know.

Face Masks … Did you ever wonder why some face masks sell for $15.00/box and others for $3.95? There is a difference in the filtration and how long the mask is effective. A top quality face mask loses most of its filtration ability after 45 minutes. After 60 minutes it is just keeping out dust. The lesser quality brands are good for about 20 minutes but unfortunately most people don’t know that, it’s all about price. The CDC recommends Level 3 face masks.

Gloves … Nitrile is a CDC suggestion due to the fact that 10% of the population has some form of latex allergy, that’s one out of every 10 patients that walk into your office. Just like masks, a $2.95 box of gloves can not be compared to a $9.99 box. Where are gloves made? Economy gloves have microscopic pin holes. Microbes can enter through those pin holes plus the glove may tear easily.

Autoclave Pouches … If a pouch with a color strip turns color it does NOT indicate sterile.  Lower quality pouches will not maintain a sterile environment as long as a quality pouch. Think about it, during the dry cycle moisture escapes so if vapor can exit it can also enter. The pouch is just a barrier that will wear-out sitting in a draw.

Disinfectants … There are a lot of them to choose from. The key to surface disinfectants is how they are used. Wipes are the most popular but maybe not the best. For proper disinfecting the liquid should be allowed to dry on the surface, spray bottles and paper towels do a better job. However, wipes are faster and speed up turn-around time. Also, using wipes will not expel as much vapor in the air which is not only a health concern but can also damage dental equipment. I guess it’s a trade-off.

Summery … The average dental office cannot maintain a sterile environment like an operating room, it can only attempt to control the transfer of bacteria and viruses with procedure and protocol. Masks, gloves, and barriers should be changed every time you leave the operatory. An annual infection control review is as important as OSHA & HIPAA training. For my clients I provide a free one our lunch & learn review with CE’s. Please free to contact me at any time with any questions or concerns.

January 6, 2019 Posted by | Uncategorized | Leave a comment

Reflections of Dentistry 2018

Closing out a year of business is like approaching the finish line in a race or scoring a goal. Most of the NJ/NY dental healthcare community has finished up. Now take a deep breath because January 1st it starts all over again.

This is the time when we look back on the past year and reevaluate procedure and protocol. It’s time to take ownership of all the successes and failures as an organization and fix the things that don’t work while enhancing the ones that do. Let’s start with the single most important asset, the team.

The Team … In this ever evolving healthcare market an investment in personnel and infrastructure is absolutely necessary. When I walk into a dental practice and hear an owner or manager say “we just can’t find good help” or “I can’t find a good assistant”  I know they don’t understand team management. Team members are not there to “help” or “assist” you, they are there to support their own lives. A team leader’s job is to get everyone to do what they don’t want to do and enjoy doing it, that is not easy. The best way to accomplish this is to “Show them the Money”.

Show Them the Money … Let’s face it, pay peanuts & get monkeys. But, you can’t keep giving raises for two main reasons. First, you can’t afford it and second, it is not healthy for the team. If you continue to give raises you will eventually price your team out of the market and when the day comes that you can’t give anymore dysfunction begins. If you want people to help you make money, you have to let them make money. So, why not give them the opportunity to put some skin in the game.

Put Some Skin in the Game … Every growing business needs quality team members and programs to keep them happy and loyal. Bonus based on production is the most popular because it is a transparent and can be set-up on a quarterly basis. These programs almost always have a positive effect on the bottom line. There may be several revenue generating projects you have such as Sleep Medicine, Clear Aligners, Internal Marketing, etc. Have one separate team members focus on each and production will grow. Project leaders will also feel good about their successes. The real golden handcuffs that retain quality personnel are added benefits.

Golden Handcuffs … The unseen value that the millennial workforce is looking for. Healthcare and 401k plans are important for a smooth functioning team. I see practices everyday that offer benefits and others that don’t and there is a difference. Top line talent want a career with opportunities. Years ago I was offered a great position with a well respected company and I turned it down. The reason was that I didn’t see any younger management being offered long term opportunity and that limited company growth. Trained talent moved on to competitors for a better package.

The Package … The package is everything. When you combine a competitive wage with benefits and bonus on production that is tied to a 401k you are not only showing your team you are investing in them, but you are asking them to be part of the future. Now you have a team that has a reason to preform and be accountable for their failures and successes. Now it is time to lead.

Team Leader … You must be involved with every phases of your practice. You don’t have to know how to do everything but you do know what to expect from a good team.

December 31, 2018 Posted by | Uncategorized | Leave a comment