DMD Staff

Embezzlement can happen in any dental practice. Do you know how to spot it in yours? Pat Little, D.D.S., F.A.G.D., C.F.E., CEO and Founder of Dental Risk Concepts and 

, outlines some key warning signs to help sniff out an embezzler in your practice. Step one is looking for cash-flow issues.

Interview Transcript (Modified Slightly for Readability) 

“Really the most common warning sign (of embezzlement) that we see is the dentist has cash-flow issues. My first embezzlement course that I presented was called ‘Working Harder But Earning Less,’ and that actually came from my very first client. He said, ‘Pat, I don’t know what’s going on. I’m producing more than I’ve ever produced, but I’m broke.’ That’s probably the number-one warning sign that hits the doctors when they finally can’t pay the bills. Or they’re getting calls from a vendor saying, what’s going on?

There are some other warning signs that might lead up to that. One thing that can happen sometimes is there’s a lot of staff dissention as well. The embezzler will intentionally sew dissention so that the embezzler is the only one not causing a problem in the office. That makes the doctor trust the embezzler even more.

But really, for most doctors, the number one warning sign is there either getting a lot of complaints or patients complaining about their incorrect statements, billing issues. Typically, most doctors really notice it when they start seeing their cash flow go down.”

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Embezzlement can happen in any dental practice. Do you know how to spot it in yours? Pat Little, D.D.S., F.A.G.D., C.F.E., CEO and Founder of Dental Risk Concepts and Prosperident, outlines some key warning signs to help sniff out an embezzler in your practice. Step one is looking for cash-flow issues.

How to Spot Embezzlement in your Dental Practice

Brandy Keck, is a brokerage liaison at Carr Healthcare Realty, a firm that specializes in selling and buying real estate for medical professionals. 

Practice Real Estate: Your Quick Guide to Making the Major Purchase

Brandy Keck, is a brokerage liaison at Carr Healthcare Realty, a firm that specializes in selling and buying real estate for medical professionals. Keck sat down with Dentist’s Money Digest® at the Yankee Dental Congress to give dentists advice on the practice real estate purchasing process. Assembling the right team of experts, she says, is critical to making the process work.

Do not talk to the seller directly. The dentist will want representation in the form of a team of experts. “Dentists are really great about bringing in their team,” Keck says, including contractors, dental-specific CPAs and attorneys. A real estate broker, Keck says, is essential to deal with the confrontational aspect of the transaction. Which leads us to …

 “Something that can be challenging for dentists can be the confrontational piece of what it’s like to work with a landlord or a seller directly,” Keck says. This can be especially difficult in lease-renewal situations where the dentist knows and may have a good working relationship with the landlord.

 Even if you love it, don’t buy the first practice that you see, Keck says. Look at multiple properties in the same market. Have all the information about the advantages and disadvantages of each at your fingertips. “There really needs to be a posture and an education on multiple properties at one time, separating the dentist from the transaction.”

 Keck recommends working with a demographics firm to determine the demand for dentistry in each area. Dentists need to know if a given market is growing. “If there’s a market that’s booming right now and a lot of population moving into an area, there’s going to be a need for dentists coming up.”

When weighing their options, Keck says dentists should consider the stage of their career. Straight out of school, a dentist’s debt load might be too large to take on added real estate costs. Additionally, buying gets complicated if a dentist is considering relocating in the future.

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Brandy Keck, is a brokerage liaison at Carr Healthcare Realty, a firm that specializes in selling and buying real estate for medical professionals. Keck sat down with Dentist's Money Digest at the Yankee Dental Congress to give dentists advice on the practice real estate purchasing process. Assembling the right team of experts, she says, is critical to making the process work.

Scott Parazynski, M.D., is the only astronaut to have summited Mt. Everest. His career in the space program and taste for adventure have taught him a few things about managing risk, a subject he lectured on at the 2017 Hinman Dental Meeting. In this clip, Parazynski, who is also the CEO of Fluidity Technologies, explains how risky environments have taught him about risk management.

Interview Transcript (Modified Slightly for Readability)

“Going into extreme environments forces you to think about risk in a different way. People oftentimes look at my career as being highly risky. However, I don’t consider myself a risk-taker. I very much consider myself a risk manager. Understanding the challenges out in an environment, trying to mitigate those risks the best I can with training, with equipment, with a good selection of my teammates, using technology to our advantage to improve the outcomes. It’s worked really quite well, taking me to space, to the top of Mt. Everest, deep in our oceans, and it’s been a wonderful career. It’s also been a wonderful catalyst for innovation, using extraordinary environments as a source of inspiration for developing new technologies.”

Scott Parazynski, M.D., is the only astronaut to have summited Mt. Everest. His career in the space program and taste for adventure have taught him a few things about managing risk, a subject he lectured on at the 2017 Hinman Dental Meeting. In this clip, Parazynski, who is also the CEO of Fluidity Technologies, explains how risky environments have taught him about risk management. 

Rethinking Risk in Extreme Environments

Increase Patient Flow, Profit, in Your Dental Practice

“The way that we establish performance goals for patient flow and profitability begins with the profitability issue. How much do we need to make? That is the first step.

As I’ve said countless times in all of my presentations for the past 30 years, we need to know your number, and that number is profits. That really takes an assessment of your personal budget. How old are your children? Are you in a marriage? Are you in a relationship? Do you have school debt?

The school debt that graduates have today, approaches $500 to 600 thousand dollars in some cases. When they’re a specialist, it can approach a million dollars. It’s going to take a significant economic event to occur every year to be able to fund that obligation for the next 20 years. That’s where we begin with the business budget. It has to fund the personal budget.

Then we assess the doctor’s comfort level in assessing patient flow, staff members, et cetera, and that will give us the confidence to help them commit to the right-sized facility. We’re fans of a minimum of four operatories per general dentist. That will allow the dentist to have two operatories for themselves, and two for their hygienists. The concept of a one-hygiene general dental practice doesn’t create enough recurring patient flow to keep the doctor busy from that internal source of patients. They then become new-patient driven, and then we end up with the dilemma of, I don’t have anywhere to put the new patients in continuing care, so how do I take care of them? It creates a crisis.

But once we assess what the economics are — production, collection, insurance, overhead, profitability – now we can establish the goals. And goals are broadly stated initially: I want to fill my practice up with happy patients. I want to fill my practice up with loving and happy colleagues: dental assistants, hygienists, assistants. I want everybody to love my vision and mission and be a part of it with me. But they’ve got to understand what that is so that they can buy into it.

Then we break it down. Each major goal has a subset of goals, and those subset goals may be, I need X number of new patients. I need a percentage of those new patients to accept treatment in order to fund the minimum production levels I’m anticipating in my budget, every day, every month, every year. From that group, I need a certain percentage of them to reappoint for their continuing care, because in a general dental practice, we want to grow the continuing care pool. We don’t want to just meet patients and then never see them again.

Dentists, I always say affectionately, are farmers. They grow a crop of patients much like I did in my accounting firm a number of years ago. And I took care of them, on and on, ongoing for years. Specialists, they’re more like hunters. They get the patient, they see them, and they’re gone. We have specialists as clients. They’re different from a general dentist. They’re not growing a pool. They need to find a recurring patient pool to tie into typically within the referring group.

Once we know what the patient count issues are — new patients, reappointment percentage – we can assess how large is that continuing care pool going to be. As a matter of fact, that’s the very first statistic we work on. If you’re going to have two hygienists, we know the number of patients you have scheduled in hygiene will have to be somewhere between 12 hundred and 15 hundred patients at maturity. If that isn’t a large enough pool to keep you busy, doc, you may have to grow to a third hygienist, although that can be a limitation in some states due to the dental practice act. That’s the first one. We need to know our body count. And we want to close the back door and have a 90 percent or higher reappointment rate.

Secondly, what is our daily production goal? For the doctor, it’s based on a combination of things: their clinical philosophy, the type of procedure mix that they subscribe to, the fee schedule, their proficiency, are they using technology to get the work done, are they doing the majority of the work, are the assistants helping them wherever legally possible.

The hygiene department goals, well that’s something based on something altogether different. We have to establish what the doctor’s clinical philosophy is for treating patients with periodontal disease. We have to conduct a survey to determine what percentage of the patients have those diseases so that we can estimate the various procedures we’re going to do based on our survey of our patient pool on a daily basis for adult prophies, child prophies, scaling and root planing, and associated services that are offered.

That establishes the hygiene goal. Once we know what these providers are going to produce, we know how many days they’re going to work, we can forecast the annual revenue. Next, we have to assess the collection percentage. Not everybody collects 98-100 percent of what they produce because they’re in network with a reduced-paying insurance plan. If that’s the case, then we have to calculate what the reimbursement rate is going to be, and that establishes our collection percentage.

Associated with that is our accounts receivable balance to production ratio. Nobody wants to be owed money from customers. There’s an old saying on the golf course, fast pay makes fast friends. Dentists and all small business owners are not large enough to be able to house a finance department to continue to bill and collect. Collecting copayments at the time of treatment is essential. Collecting from insurance companies within network within the period of time they pay has got to be determined as well. That will allow us to establish that percentage. Case-acceptance percentages are established as well and then associated reactivation efforts.

All of what I just described will generate production and collections. Once we know what that is, we have to come back to our overhead assessments for dental supplies, lab, advertising, occupancy, labor, general administrative, associate comp, debt service, all of these things that drive cash flow, and then of course, your CPA can pick it up from there and calculate the number of depreciation, amortization, and your tax liability, but that’s how we go through the process.”

It's simple: All dentists want to increase patient flow and profits in their practices. What's complicated is achieving those goals. In this video, Kerry Straine, CPBA, CEO and President of Straine Consulting, walks dentists through the steps they need to take to achieve those goals. He says that for dentists, it all begins with establishing a personal budget that considers factors such as marital status and student loan debt.

, a company that works with medical professionals to help them connect with patients. From his experience, Sawyer says that many dentists are excellent clinicians, but poor leaders. To drive business growth in dental practices, dentists must set clear performance standards and hold their employees accountable.

Interview Transcript (slightly modified for readability)

“What are some leadership tips to give dentists and their staff? Number one would be to establish and understand that it is, in fact, a business and that somebody is in charge. A lot of times, what happens is — and we work with hundreds of practices in four countries, and so you see the same model played out over and over again – you have the dentist who went to school for 12 to 15 years, all he or she does is want to work on teeth. They’ll go out and get a practice manager, and then they’ll put a ton of trust and they’ll put a ton of authority into a single person whose agenda is sometimes at odds with the business interest of the practice.

For example, you’ve got a practice that’s trying to grow and the dentist wants to introduce marketing strategies, whether it be social media, email marketing, SEO, or they want to introduce a new piece of technology so that they can get more inquiries into the practice. A lot of times the practice manager will be tasked with that, who in fact has no interest in seeing any more patients or getting any more patients in the practice because they’re already overworked.

Setting Priorities: An Essential Dental Leadership Skill

Getting the Most Profit out of a Dentist’s Schedule

Getting Dental Patients to Leave Positive Online Reviews

So first, what has to happen is the dentist needs to establish that they are, first of all, in their own brain, and secondly, by vocalizing to the people, is that they are, in fact, in charge. Then they need to get respect. How does that work?

If you want people to perform certain tasks, number one, you have to hold them accountable. So, if you’ve got a person in Boston who’s responsible for selling shoes at Nordstrom’s, and they don’t sell shoes for a month, they’re fired. If you go into any medical practice — whether it’s a dentist or a podiatrist – you’ll see people who have been there for 25, 30 years, they’re totally non-compliant, they’re not acting in the best interest of the practice, they’re just there. And the dentist says, yeah, but she’s been with me for 40 years, or 20 years, or 10 years. I couldn’t imagine working without her.

That’s not leadership. That’s the opposite of leadership. What has to happen is, the dentist has to understand that that is their business. The laws that apply to Nordstrom’s and Crystal Clear Marketing, and every other business also apply to them. There has to be command and control. There has to be management and oversight. There has to be meetings to discuss, are we acting in accordance with our vision? They have to set the vision. They have to put metrics in place to hold people accountable to the vision. And then they have to be able to make tough choices when people for long periods of time are completely non-compliant, and they have to understand that just because you tell somebody you want them to do something doesn’t mean they know what to do. You have to explain to them what that means and there has to be training involved. Real training. Not just, hey, go to a seminar and do this, but real training. And then to sit in a room and actually show to a person who’s in charge — the dentist – that you can perform what I’ve asked you to do. And accountability, accountability, accountability.

If they could just get that done, their offices would grow, they’d see more patients the way that they want to, and they would have less chaos and drama inside the office.”

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Tim Sawyer is president of Crystal Clear Digital Marketing, a company that works with medical professionals to help them connect with patients. From his experience, Sawyer says that many dentists are excellent clinicians, but poor leaders. To drive business growth in dental practices, dentists must set clear performance standards and hold their employees accountable. 

Reduce 'Chaos and Drama' in Your Dental Practice with Leadership

Dentists are often confronted with making the choice of targeting new patients or existing patients with their marketing efforts. The right approach, according to Blair Drenner, vice president of strategic business development at eRelevance Corporation, is determined by the maturity of the dental practice.

“The important factor in determining whether you’re investing in new patients or existing patients is really the maturity of the practice. You have to spend the premium, if you will, to drive in new patients through the door when you first open your office. Once you get to a thousand patients, it’s really a matter of cost, and because the cost is much lower on your existing patient base to drive repeat business, you need to quickly and as soon as possible get messaging to that audience. You can drive a thriving practice with just a few hundred really good patients in your practice.”

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Have Your Dental Patients Keep Coming Back

Should Dentists Target New or Existing Patients With Marketing?

When to Add an Associate Dentist or Partner in Your Practice

There are certain indicators that will let you know it’s the right time to add an associate dentist or a partner in your dental practice. Kerry Straine, CPBA, CEO and President of Straine Consulting, explains what those indicators are. In this clip, Straine also stresses what a potential associate dentist or partner must demonstrate before you can even consider them for the roles.

“I’m often asked, when is the right time to hire an associate, or possibly bring someone in to become a partner in the practice. Assuming that it’s not due to a retirement or a disability, that time is when there’s enough patient flow and production within the practice so that the addition of an associate doesn’t cannibalize the owner’s production.

Nothing could be more challenging for the owner than to have hired an associate and not have an adequate amount of patient flow and corresponding patient production to keep them busy, especially when the profitability associated with the practice at that time is marginal. That is, the doctor is pulling out all of the profits and not accumulating working capital, which appears on their balance sheet in the form of money in their savings and checking account.

We look at when that practice is profitable, according to plan, and we have more patients creating treatment that needs to be done than the owner or the seller can keep up with and or more exams, always while maintaining our level of profitability as designed, then we know we’ve got room to bring on an associate without negatively impacting the economic situation for the owner.

Often times, the associate may be able to perform or be willing to perform certain procedures that the owner has referred out, or hasn’t got a chance to get to. That can also compliment the situation.

Again, when there’s excess demand for exams and production according to the supply we have — the time the owner has available – then we know that we’re at a tipping point. One of those options is to possibly bring an associate into the practice, and if not that, certainly move out of network with insurance plans or increase fees, are all ways to relieve some of that stress.

When we’re looking at bringing on a partner, it’s safest to have confirmed that the candidate is the right candidate, having been in an associate’s position for a minimum of four seasons — spring, summer, fall and winter. They’ve shown up to work on time, participated in all of the management process activities of training, huddles and staff meetings, and even maybe have sat in on some of the executive business decision meetings, taken on some responsibilities. Know that they’re going demonstrate – once they’re owners – the commitment level that the original owner has made.

Just because someone buys a practice doesn’t mean they can sit back on the couch and recline and go, ‘Ah, everybody reports to me.’ We have a saying in our organization: Owners have all of the responsibilities and none of the rights. Your team members have more rights than we do, and certainly, our customers — our patients – do as well.

If we can qualify that candidate, not only from their commitment level, the timeliness of them getting their work done, the quality of getting the work done. And the integrity of the individual.

The last critical piece of information that I have found to make for the most successful transition — and we’ve been involved with probably over a thousand team members over the years transitioning into ownership – is that their production level comes within 15 percent of the seller’s before they’re allowed to buy in, because if that associate can’t produce to the level of the owner, then the owner is going to sacrifice some of their income to fund the buy-in.”

There are certain indicators that will let you know it's the right time to add an associate dentist or a partner in your dental practice. Kerry Straine, CPBA, CEO and President of Straine Consulting, explains what those indicators are. In this clip, Straine also stresses what a potential associate dentist or partner must demonstrate before you can even consider them for the roles.

Are Your Dental Practice's Marketing Efforts Paying Off?

Do you feel like you’re paying too much in acquisition costs to bring in new patients and retain old patients in your dental practice? You might be, but you won’t know for sure unless you’re tracking your return on investment, says Blair Drenner, vice president of strategic business development at 

. In this clip, he explains where your efforts should be focused and how you should be tracking them.

“The absolute, number-one key in reducing acquisition cost is first of all, you have to measure the amount that you’re spending on acquisition both for your new customers and your existing. It’s crucial to understand what’s going in and what you’re receiving back in every single different dimension of what you’re spending on in your marketing realm, whether it be websites, SEO, pay-per-click, or your customer marketing.

The second is understanding the roadmap of how to decrease acquisition costs by removing focus from driving new patients in the door and quickly getting to the point of driving repeat business through customer marketing. It’s far less expensive to drive repeat business through loyalty programs and repeat business through your existing clients than it is to go try and get new ones.

We find that once you’re at 1,000 patients in your database, you can cultivate a huge, growing practice just with that repeat business.”

Do you feel like you're paying too much in acquisition costs to bring in new patients and retain old patients in your dental practice? You might be, but you won't know for sure unless you're tracking your return on investment, says Blair Drenner, vice president of strategic business development at eRelevance Corporation. In this clip, he explains where your efforts should be focused and how you should be tracking them.

, prioritizing the procedures that drive the most revenue in a dental practice is a problem for the practice leader — the dentist – to solve. This process begins with delegating anything that the dentist his or herself doesn’t need to do. Then, it’s a matter of fitting everything else that goes on in the practice around those core procedures.

“First, I have to define what is the highest and best use of my time. That, again, is leadership. We don’t want the dentist doing things that somebody who is talented and credentialed can do outside of him. That’s number one. In other words, what can he or she move over to somebody who is not the dentist themselves? Then, it’s focusing on, again, what are the things that are going to drive the highest revenue?

These folks (dentists) are typically very good at time management. They’ve studied for dozens of years and they know how to manage a 12- or 14-hour schedule. Where a lot of folks sometimes miss the mark is, what should I be doing? I don’t think it’s an issue of, how do I fit all of this in?

Marketing Strategies That Make Dental Practices Thrive

For example, a quick story of ‘The Big Rocks.’ There’s this professor who tells this story of ‘The Big Rocks.’ He takes a mason jar, fills it with water, drops in the big rocks, and then asks his calls, ‘Is the jar full?’ And of course the students say, ‘Yes, the jar is full.’ Secondly, he puts in some sand. And then last, he puts in the water, and he says, ‘What’s the lesson here?’ And they say, ‘You can always be better at managing time. You can always put more into your schedule.’ And he says, ‘No, the only way it works is if you put the big rocks in first.’

So, what the practitioner has to establish and understand, the big rocks are those treatments and procedures that drive the most revenue and keep the folks coming back.”

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According to Tim Sawyer, president of Crystal Clear Digital Marketing, prioritizing the procedures that drive the most revenue in a dental practice is a problem for the practice leader, the dentist, to solve. This process begins with delegating anything that the dentist his or herself doesn't need to do. Then, it's a matter of fitting everything else that goes on in the practice around those core procedures.

Brandy Keck is a Brockerage Liaison at Carr Healthcare Realty. In this clip, Keck discusses the considerations that must be made before a dentist decides to relocate their practice. It might make sense, Keck says, if the price of relocation can be offset by increased productivity, or increase the potential sale value of the practice down the line. Landlords, Keck says, also sometimes offer dentists generous tenant-improvement allowances.

“The largest transaction in real estate per deals done each year are renewals. When a dentist is building out their office, it’s very expensive. For them to start that over and relocate can be very pricy. However, the economics of it can make sense.

There are landlords who are willing to give a very large T.I. (tenant improvement) allowance to move and get them into their space. Dentists are a high-quality tenant, so landlords are very eager to get them into their spaces. There’s also something to be said for, if a dentist is maxed out in their three-operatory practice right now, it may not be beneficial for them to stay in that current location. It may make more sense for them to relocate, add that fourth, fifth operatory. The production goes up per month in each one of those chairs and they can make it up on the back side of that. So, it can make sense to relocate in those scenarios.

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If they’re looking down the line and trying to figure out an exit strategy for the practice and they’re trying to decide, what’s the best thing for them for their nest egg, which is the practice when they sell it, what’s the better location? If you’re looking at it as a new dentist coming in to buy your practice five, 10, 15 years down the line, does your current location make sense, or would it have been better to have relocated five, 10, 15 years ago and gotten the location that would have been better for the practice.

Again, it would be a matter of weighing all the options, maybe sitting down with your entire team and figuring out relocating or staying in the current location.”

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