Dr. Hugh Doherty DDS

	Today, numerous dentists are still asking the big question, “What does it really take to have a highly successful dental practice in this new economy?” Recently I interviewed Eric Nuss, Director of the Henry Schein Dental Business Institute, to learn more about the Institute and what it offers to dentists.

	You can read Part 1 of the interview to learn more about the Dental Business Institute's program 

Most dentists have zero inclination to become good business people because of the lack of business education in the dental schools. How successful have you been in making significant changes in the business of dental practices?

	So far, and in a very short period of time, we have had a handful of participating practices that have actually made practice acquisitions. I believe that speaks volumes about our curriculum and approach to helping our dentists think about growth. Four of our participants in the first class bought additional locations between the first and second session of the four sessions that we teach.

Related reading: The most innovative, unique way to grow your practice: Part 1

	Clinically dentists are superstars, but administratively they have no idea where to begin.

	That’s right. I have spoken several times at several universities, and have asked by show of hands, “How many of you are interested in running a business, a dental practice, and owning it in the next three to five years?” There are no hands. And I don’t know if it’s the way I am asking the question or if they are working on their clinicals or what they are doing, but they were not raising their hands.

	What is the greatest frustration you think plagues solo practitioners today?

	The single practitioner has staff that is supposed to be helping with marketing and insurance management and HR, etc. But who is actually doing the HR, the marketing and all these different pieces and different parts within that practice? Practitioners often realize they are the ones doing it.

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Dr. Howard Farran mentions in his book on business that the three most important factors are time, money and people. Does this mean that with what you are taking on board now, you could be taking time away from the chair?

	Yes, but I want to answer that with two parts. The first part is that we are teaching the doctor how to forecast. Forecasting as a concept in business that is very common, but for dental practice creating forecasts is difficult. That means you have to identify how many patients you are going to have in the practice, patient value in revenue and overall overhead projection.

	This is important so that practitioners can figure out where they need to reinvest money back into the practice to either replace production or create a bigger machine to create the revenue that they want. The second part is that we are working on building another class that is specific for office managers. The Business Institute is meant for owner/doctors. The next class will be office manager institute or something along those lines.

So, tackling some of these areas that often bog dentists down, how do you approach and cover metrics and numbers and compensation plans in the dental practice? 

	The metrics and numbers in the practice are so important that we cover this in every one of our sessions. In the planning session, we talk about the practice goal, whether that is revenue or patients or locations or income or a sale price. Let’s work backwards from there. That is not my number to determine. It’s their plan, so we start there. We guide them down a path of understanding, not only forecasting but also modeling a financial decision. At what point does it make sense to pull the trigger, or to make the investment, or to digress or sell or buy, or whatever the decision ends up being? When we are planning, we really focus on weight points, financial projections and trajectory.

	We talk about compensation plans in our leadership and HR class. We cover compensation quite extensively in regards to compensation for doctors, hygienists and office management staff. We talk about not only how to set that up but how to model it, because in this environment we are trying to teach duplicity: If I am going to do this one time and it works, why would I not do this over and over and over? If that’s your goal, how do we create duplicity?

	The second part to this is we show them how to evaluate if the compensation plan is actually motivating. We teach them to create a compensation plan that generates income. If I am paying the employee $100,000, but the production is less than overhead and comp, is that a good deal or a bad deal for the owner? Clearly it’s a bad deal, unless there’s a secondary benefit, called good will, for that person being a part of the practice. It’s important to understand if your comp plan is out of alignment with production. Again though, it’s not us necessarily saying, “OK, here’s the number.” We get asked that a lot-what’s the number? What percentage of expenses should your payroll be? The number has to work in your system. Because if I say the number is 30 percent, but your operating overhead is 78 percent versus 60 percent, I can’t give you 30 percent, because it doesn’t work. If I am giving you 30 percent, I got 10 percent left on 60 percent. I am “in the hole” at 78 percent.

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In terms of expanding, what factors do you think come into play when you purchase a practice?

	I am buying a business that has an existing cash flow. I am investing in something that is going to have, hopefully if things are done correctly, repeat income in that practice. And if I build a practice from scratch, I better be going in with the right intentions, and that likely is because I have exhausted my capacity of the original location.

	 So the weigh point for expanding from scratch starts with a discussion about capacity. The weigh point in buying a new location is not just whether or not the deal make sense. I think a lot of doctors get lost in this metrics. Is it a good deal or is it not a good deal? It’s a good deal if culturally there’s alignment, and it’s a good deal if there are patients in the practice that will continue to be in the practice. The most important number in the entire set up is the number of patients in the practice.

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These are all very important topics. Why didn’t you attempt to educate the dentist over the Internet? It might have been better, faster, smarter, more efficient and less expensive. 

	The reason why we did not do an web-based program is that you cannot have the experience of group work. You cannot have that experience of “I’m in a new environment.” You cannot have that experience of role-play and simulation. You can’t have that emotional connection of walking into a space that you aren’t sure how to navigate. The Henry Schein Dental Business Institute is unique in the sense that it is an experiential learning environment.

	If this was just lecture, absolutely this could be web-based. Because this is activity-based, and because it provides building blocks of concepts that need to be reinforced with engagement, there’s no way to be able to check for understanding and bear witness to the growth and development that tells me we have been successful.

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What is the top benefit of making the Institute a brick-and-mortar program (rather than online) to help educate dentists about business?

	We are in Orlando right now, where Walt Disney’s home base is. When you go to a place like Disney, they create an amazing experience from the moment you start thinking about planning a vacation to when they swipe your wristband to walk into the park. The new rides and new this and that, and the concept of that amazing experience that they have, is really at the core of this. I really believe that we have created an amazing experience for our doctors. We don’t have to market, because they tell everybody they know about it.

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So word of mouth is pretty important for you?

	Word of mouth is truly huge for us. When doctors enroll, we have an interview. I interview the participant to get to know them, understand their goals and their vision, and to let them know what they are walking into. I ask them goofy questions like who is your favorite superhero? If you could have a super power what would it be?

	All these questions are with purpose. I also ask them what their favorite snack is, because it’s important. If they are going to be in a foreign environment, I want them to have some creature comforts. When they arrive at the hotel, there’s a special gift bag customized for them. Nobody’s gift bag is the same. It’s based on what I have collected in that interview. That means something when they leave; having that personal experience is most important.

I understand that you do a webinar in between each session. What is the value of doing so?

	Once everyone returns home between each session, we do one-on-one advisory calls, and also do a webinar to reinforce the material and prepare them for the content of the next class. In between the first class and second class we are going to have a webinar for the community. We record it, and then we send them a link to that class. That webinar is usually an hour to an hour and a half, and then we do a one-on-one advisory call that is usually about an hour.

	On those one-on-one advisory calls, I always tell the doctor to include the office manager, assistant or associate, if they feel it would be appropriate. This is the opportunity where you don’t have to bring your entire team to the Institute to reinforce content. You, as the leader, should go back to the practice reinforcing what you learned in this class, and teaching your team about what you picked up and how you are going to implement things. Then when we have our one-on-one call, it isn’t just one-on-one-it’s also for your team. So if you want to bring all those other folks into the conversation, you absolutely can.

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What is your take on consultants as educators providing business education?

	Here’s my take on consulting in general: We work with several consultants who are the best of the best and advise people to work with them. Generally speaking, consultants have a philosophy of doing business or practice management in general and then they teach people how to aspire to that philosophy. They motivate people with carrots and sticks along the way, whether or not they are adhering to that philosophy. At the end of the philosophy, of the practice management concepts, in many instances, that’s where it stops. With our education, what we are trying to do is give them a very meaningful and real reference tool.

What has brought you the greatest satisfaction with the Institute?  

	Knowing that doctors are applying the information in their practices and seeing their practices grow. What’s really important from where I stand is that this is not a cookie-cutter plan. I think the Institute has allowed people to cast their vision and put together a plan that can be tested, vetted and reviewed, allowing them to be able to actually carry it forward.

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If we were sitting here in a year celebrating what a great year has been for the Dental Business Institute, would you say were the biggest successes or things that contributed to the Institute’s success?

	I will measure our success by the success of our students. Another factor of success would be that our future classes continue to be full and there is a demand. Our marketing efforts are diminished because of the positive word of mouth, and we’re seeing that right now.

	This has been a team effort. This is definitely not a one-man program. We have a lot of contributors that are bringing a lot of expertise into this program. But orchestrating that and pulling it off was and is not an easy task.

	The Dental Business Institute supports the overall mission of Henry Schein. We believe that we make an impact on the lives of those we touch because we focus on practice care so our customers can focus on patient care.

Eric Nuss leads the Business Solutions Department at Henry Schein Dental. He developed and leads an educational program for dentists, the Dental Business Institute, for the entrepreneurial dentist. Eric has a degree in Education and an MBA in Business, in addition to almost 15 years of industry experience in leadership, sales and education. Prior to his current position, he was the regional manager with sales and operations responsibility in Iowa, Nebraska and South Dakota.

Dr. Hugh Doherty is a Certified Financial Planner, national speaker, author and business and financial coach to the dental profession. He is the founder and CEO of Business of Dental Practice LLC, a company dedicated to coaching only dentists to develop and implement cutting edge business strategies. His varied background in the field of dentistry, years of research and study at Harvard University Graduate School of Business and the College of Financial Planning, make him uniquely qualified to educate in all aspects of the business and financial world. He can be contacted by email at 

Articles

Today, numerous dentists are still asking the big question, “What does it really take to have a highly successful dental practice in this new economy?” Recently I interviewed Eric Nuss, Director of the Henry Schein Business Dental Institute, to learn more about the Institute and what it offers to dentists. You can read Part 1 of the interview here.

The most innovative, unique way to grow your practice: Part 2

	Today, numerous dentists are still asking the big question, “What does it really take to have a highly successful dental practice in this new economy?” Recently I interviewed Eric Nuss, Director of the Henry Schein Dental Business Institute.

	Eric is the most astute, innovative, entrepreneurial and caring educator it has been my privilege to meet. After a two-hour interview, I was able to grasp and understand his unique method of teaching dentists a completely one-of-a-kind method to excel in business. Unfortunately most dentists think the correct path to success is to become a “clinical superstar.” Sadly, the result will be a failed administrative system due to a lack of business knowledge.

How did your idea of the Dental Business Institute come about?

	The idea came as a result of building the Henry Schein Dental Business Solutions Portfolio. We’ve always recognized that doctors are business owners and must treat their practices as business enterprises. We discovered that they needed coaching and/or consulting because they wanted to be more efficient and profitable. And that’s exactly what we can do with an array of coaching and consulting resources, service provider or business education.

	When I went to get my MBA, it wasn’t just with the intent of learning about business. I also went in with the secondary intent of understanding how adults learn. What I discovered was that whether you’re a sixth grader or an adult professional, you learn pretty much the same way. Everybody learns from doing things. That really was the crux of the idea: Presenting business education for dentists, but in a way that they never experienced it before.

What ignited the spark for you to start the Dental Business Institute venture?

	The idea itself was inspired by Stanley Bergman our CEO, who often talks to our sales force about “intrepreneurism rather than entrepreneurism.” Intrepreneurism focuses on working within a company and coming up with creative ideas to help our customers or our business. So it’s within that spirit and that we have the opportunity to create something that would help our dentists in a new meaningful way was a business education achievement. That was definitely the start.

In the beginning, what was your mission for the Institute? 

	Our goal with the whole program, and the goal for me personally, are for the doctor to recognize that he/she is a small business owner. Their job is to manage and build that business into something that is amazing. Their small business is selling a product and that product is oral health.

What is the teaching strategy at the Institute?

	At the Henry Schein Dental Business Institute, we really believe that participant doctors working together on ideas will learn that much better. When we give them a concept, they have to play with it. Quite literally they play with these ideas, because business ideas and challenges are presented every day in their practice, and it’s about how they handle these ideas, isn’t it? We have Legos in the middle of the table, and there is a box of toys to help provoke thought and action.

	This approach to learning challenges the orthodoxy of traditional business education. And that is our goal. People are set up in pods rather than in rows, because they work in teams. We are teaching people how to work collaboratively and effectively. That only works when you can see your partner and you are working in conjunction with each other.

What are the essentials that make up your educational process for the Institute? 

	I use a scientific method, because I was a science teacher. With science you have to always be curious. Ask yourself the following questions. If you are not looking for the answer to the problem, why are you here?  What are you really seeking to accomplish?  Scientific method is the first part of a sixth grade education. It is the first time that a student starts to understand the process to develop their own curiosity. Of course kids are always curious. But if we reinforce the scientific method in a classroom environment for professionals, and peel back all of the layers of junk they have accumulated over time, so that they can just go back into learning mode, and learn what they want to learn, rather than subscribe to a process or philosophy, the education is theirs. Like I said before, they are brilliant instructors, they will learn more from each other because they are experiencing and experimenting and asking questions and being curious about what’s working and what’s not working.

How would you refine this system and how would you do this differently?    

	A doctor states, “I’m ready to hire a new associate… how do you think I should pay them?  We can stand at the front of the room and say you should do it this way, and you should cross this “T”, and you should dot that “I”, and here’s my philosophy. No doctor, here’s a list of 10 different things you should consider. However, at the end of the day, it’s your decision to make. You need to understand what would be the outcome of every one of those decisions. That’s the purpose of the simulation, is to understand what happens when, where and how. Along the way if I am setting goals, what is the next point that I need to cross in order to take the next endeavor?  Is there another practice? Is there another doctor? Is there a revenue number? Is it a patient count? Is it I’m booked out so many weeks? It’s a different number for different people. And it’s a different metric for different scenarios, and it’s in the eye of the beholder. What we are trying to teach them, is that there is the framework, here’s the process, rather than, we want you to do dentistry this way.

What is the basic structure of the program?

	During the first two days of class, which are always Thursday and Friday, there’s a little bit of lecture and then additional activities related to the session theme. In the first class for example, the planning class, we have a workshop on building a mission and purpose statements. Then we do communications training to teach them about how to communicate that mission and purpose. The next day we cover the business plan with an Academy Of Dental Certified Public Accountants (ADCPA) member who coaches them.

	On the third day, we have marketing experts come in and talk to them about marketing plans and how that fits in the overall business plan. But at the very last day of every session, always on a Saturday, we do a full day of computer-based business simulation.

	During the first session they have a competitive business simulation to create and refine the best, most optimal, practice. They make over 140 decisions as a team, over the course of several years in simulation. They determine insurance participation and fee schedules, the number of employees, payroll and marketing. Simulation is an invaluable component of the program, so they can return home and implement what they have learned. I know it’s exhaustive, but they received a complete understanding how a business operates.

	During the subsequent time period between sessions, I have a one-on-one, one-hour meeting with each one of the participants to touch base and make sure they are following up with what they learned at the Institute and connecting the material to their real-world practice. Incidentally, the positive feedback from attendees has been incredible.

What topics do you tackle in the classes?

	In the second class, we discuss building a physical building. We talk about four elements of infrastructure: Brick and mortar, technology, money and people. The most important of these is the people. So when we talk about metrics and building, it again is a matter of weight points. When we are connecting the dots with the plan, and on an individual basis, you might say that you wanted to accomplish this in this time period, with this amount of resources and this amount of patient and this amount staff. But how are we getting there?  And when we get there, then what? 

	The building concept is more centered around, “So, we have created the plan and we crossed the threshold. Now what?” The metrics here are, how do we buy a practice or should we build a practice from scratch?  The metrics become, again on a financial trajectory, where do I see cash flow generated in that expansion? 

	In the third class we talk about HR and leadership. These are different to quantify, but from an HR perspective, it’s more of a yes/no, do you have HR or not? Do you document? Do you have a paper trail? Are the people compliant? Do you know if it’s legal or not for them to prescribe, diagnose, deliver, etc.?

	On the leadership, it is very intangible and unquantifiable. I would argue unquantifiable metrics is about whether people are happy? There are tons of examples across the country of different companies that put people at the center: Southwest airlines and Disney are great examples For Ritz Carlton, it’s all about the people. When the people that work for you are happy, they inevitably carry that on to the customer experience they create. What do they say about California cows? When they are happier they produce more milk?

	In the fourth session, we talk about lean management. This subject is very quantifiable because now we are measuring the efficiency of the systems, and success is always measured by the doctor. If the practice’s goal is to be efficient to a certain capacity, or certain ratio, then we need to refine that system to make that possible. We are here to give guidance on the process. It’s less about a number and more about a step and a sequence. Valuing the system, measuring the system, creating control, improving the system and eliminating waste. We also then teach about negotiation.

	 In negotiation training we teach that when you’re in negotiation, you should always be thinking in the back of your mind, “what’s the alternative?” If I am negotiating with a bank for a deal to fund another practice, I should have in mind what the going rate is at another location. Or if it’s not about necessarily getting a loan, but it’s about bringing on an employee or expanding the build out space in my lease, having that best alternative to negotiating agreement in the back of your mind.

What happens at the end of each session? 

	At the end of every session, they do a business simulation to develop their thoughts on where they think they are, and a roadmap to where they want to go from a business perspective. The business simulations are conducted with help from our program partner, Simulation Studios. During the simulations, attendees apply what they have learned in three steps. First, they take the scenario and make it bigger by asking themselves, "Who am I going to employ?," "how will I attract and retain patients?" and "what investments will I make?"

	Second, they ask themselves, "Which practices will I consider adding to my portfolio?" and "how will I develop the infrastructure?" The third simulation is all about delegation and leadership. Here they are asked, "how can you expand, yet stay true to the original mission once you have added more practices?" This is an important step in the process as they are taught how to delegate without giving up the business model.

	Be sure to watch for part two of this series to learn even more about the opportunities provided at Henry Schein Dental Business Institute. 

Dr. Hugh Doherty is a Certified Financial Planner, national speaker, author and business and financial coach to the dental profession. He is the founder and CEO of Business of Dental Practice LLC, a company dedicated to coaching only dentists to develop and implement cutting edge business strategies. His varied background in the field of dentistry, years of research and study at Harvard University Graduate School of Business and the College of Financial Planning, make him uniquely qualified to educate in all aspects of the business and financial world. He can be contacted by email at hughdohertydds@comcast.net. 

Today, numerous dentists are still asking the big question, “What does it really take to have a highly successful dental practice in this new economy?” Recently I interviewed Eric Nuss, Director of the Henry Schein Business Dental Institute.

The most innovative, unique way to grow your practice: Part 1

	My passion has always been dentistry and my commitment is focused on how I can enable the members of our dental profession to be successful. My travels have taken me to all 50 states and every major meeting. I am honored to present my interview with one of the true masters of the dental world, Dr. Marc Cooper, founder and president of The Mastery Company. The focus of his company over the past six years has been on group practice of all sizes. 

Dr. Cooper, the context of dentistry has changed. You have stated that we have reached a “break point” and it's not going back to the way it was. What makes you confident that you are correct about the future of dentistry?

My background includes working in a number of other industries. I’ve worked in healthcare, hospitals and Fortune 500 companies. So, I am able to look at the future from a different perspective, which allows me to look from the outside in, giving me a perception of the future from a meta view. Most consultants look from the inside out; they’ve only been inside the dental industry. Therefore, I feel I can predict the future; specifically what will happen, probably not. But in general where things that are going to change? Absolutely.	

There will be a definite change in how the business of solo practice is performed. For the last 100 years, dental practice has been performed in small solo practices, with maybe one partner. That was sufficient in the system or the context that it was in. But the context has changed, and context is decisive. With the changed context, the system has changed. Solo or small partner practice will no longer have the viability that they did in the old context. In the old days, any dentist could just put up a sign and they were in business. Not anymore.

Today dentists are holding tightly on to the past, hoping that things will get better. But it’s not going to get better. The changes that are occurring are dramatic and irreversible. When was the last time you saw a pay phone? It’s been a while, right? So what happened? It’s outdated. The current way solo docs are practicing dentistry will soon be outdated. They can’t practice like they did yesterday. What’s going to occur is that the economy and the dental healthcare system are going to call for a greater capacity to treat more patients more efficiently, which simply can’t be done within the solo practice model.

Are dentists getting ready to change their performance and learn what’s necessary to practice dentistry in the future? 

Unfortunately, no. My experience is that there is huge resistance to change. This is painfully evident when I am in front of an audience talking about future strategies for the dental profession. I truly feel the unrest that exists within the audience. They reveal their upset and anger when I present the news about what’s happening with regard to dentistry’s system, the new context and the new competition. Their reaction to these predictions of the future creates a lot of resentment in the room and the volume of their responses is overwhelming.

Why are most dentists not ready for your message?

They’re afraid of the change. In Stephen Covey’s book, 

Seven Habits of Highly Successful People, 

the first habit, “Be Proactive,” needs to be read and re-read. The truth is, dentists don’t want to hear that, but it is a truism that must be endorsed and repeated often. “If they want things to change, they have to change themselves.”

Change is difficult and it’s upsetting. The first slide in my PowerPoint presentation is one about the difference between the messenger and the message, because they really need to get the message. Dentistry has been permanently altered; it’s changed and it’s not going to go back to the way it was.

What makes you different from the other consultants? 

Great question! The benefits of our consulting are numerous. We have a whole orchestra of business resources that we can utilize. Other consultants have maybe one instrument and they have only one tune. Many consultants attempt to “fix” practices, but The Mastery Company is about the transformation of dentists as leaders and owners. I define transformation as the ability to think beyond your past, your identity and your personality, to think new thoughts, to provide a new way to see the future. We make every effort to assist our clients to develop strategies that will help them be successful in the future.

Is the objective to get doctors to think bigger? Larger? Help them have a larger vision?

When you take “you” out of the picture and insert what you want to create with your life, there’s always largeness to it. Most people are afraid of the risk, so I enable them to go for it. This is a major part of our ongoing coaching.

Describe the relationship you have with your clients.

Our relationship is like being a committed partner. Many clients have gone from single providers to multiple provider group practices with my coaching. Having taken this particular path, some end up with 7-8 practice locations. Therefore, I am engaged in various ways throughout the growth period of their transition from solo practitioner to group practice.

What is the vehicle that you utilize to convey your information to make these transitions a reality?

We have a curriculum called Get Smart in which we break them up into learning groups. Each learning group learns to operate as a Board of Directors. We train them how to think like a director. Not like an owner of a small business, but like a director of a major, for-profit corporation. At the end of the Get Smart program they are required to present a strategic plan, as a CEO of a large company. They are required to generate a model that is going to generate $25 million a year in business. Now the prize for this small group will be in terms of their ability to capitalize their futures. There is an awful lot at stake in this game.

Do you think you have the answers to change the world of dentistry implementing the different breeds of managed group practices? 

Yes and no. There is no right answer. One size doesn’t fit all. The variations in group practice are massive. I do think I have a way of coaching people to be able to see and act in a way that changes their future and enable them to create a group practice that fits their values and their region. It’s about them, not about me. I am committed and convinced that I can help turn it around utilizing different models of managed group practice. I have done this with success

Who is the typical client and what are the different services you offer? 

I don’t have a typical client, but I do have a range of clients. In addition to dentists, I coach and consult large group practices, insurance companies, biotechnical firms and companies throughout the supply chain in the area of dentistry. My typical client, though, is as much as anything else committed to success. Their driving intention is to make a difference with their lives and with their work.

How do you go about advising, consulting and coaching your clients to be successful?

We offer monthly coaching, some formal programs, in-house programs and education via the Internet. We have a pretty broad range of vehicles in which we deliver our consulting. I have also written several books. One of the most important books I have written is entitled 

. I also have clients learn from other masters such as Jim Collins, because it gives them a different perspective of what they’re working on. I find that in dealing with doctors across the board, they will read business books and study business methods and strategies.

Describe the profile of your most successful practitioners?

We have discovered that the most successful practitioners are those that are the most coachable. With clients that are very coachable, I can predict that in the end their efforts will be rewarding. I find if you ask what’s typical about the clients I work with, whether it’s a third party, a technical firm, or a small concierge practice, they are great learners and they are coachable.

My success rate goes up and down the scale. You don’t stay in this business unless you’re successful. It’s usually word of mouth that generates the referrals and the clients coming to us. So, helping dentists from solo practice to group practice is what I do. I am proud of our current record.

Let’s jump into the future of dentistry. Where is it going and what are you doing to prepare dentists for that?

The future of dentistry is large managed group practice. Right now, if you go on social media or Dental Town, where you find conversations amongst dentists, most are very much opposed to managed group practice. The truth is that dentistry is going in that direction and they don’t want to go there. They like working alone. Dentists are like eagles and eagles fly alone.

Who and what are the major forces reshaping dental practice?

The amount of revenue generated in dentistry this year was $106 billion. It’s a remarkable amount and more than the GDP of many countries. When you consider the money that is spent on dentistry, and the fact that it’s going up 5-6% a year and is recession resistant, there is huge potential for the future of dentistry. The money markets see dentistry as a good place to put their money. Investors understand that larger group practice entities have a greater profit margin than the smaller solo practices. Also, they have a capacity to generate a greater market share. Therefore, the money from capitalists is beginning to rapidly move into dentistry, mostly into group practice formation and management.

How soon do you believe that’s going to happen? 

What will happen is that these larger entities (group practices) will force the little guys, the solo practice, out of existence. They are like a Home Depot, Costco or Walmart, who killed the mom-and-pop stores.

Well it’s happening right now. There are entities called MSOs that have 300-500 practices under management and are acquiring or building 70-100 additional practices per year. It’s ambitious; it’s everywhere.

What are the options available to dentists?

Let’s look at the dentist as an entrepreneur. Our Get Smart program, which I mentioned previously, is a transformational exercise where we take the small groups of dentists who generally think in terms of “I” and enable them to think “we.”

Why aren’t dental schools teaching their students entrepreneurship?

I was involved in teaching dental students and their capacity to take all this in is nil. Information without experience has no power. They have to be working in a practice to understand the game of business. And they have to have something at stake. When you’re in dental school, the business of practice exists way over there. But when you’re in practice and you have bills to pay and staff to pay, then this stuff has a deeper meaning and penetration.

Can this process be an easy transition, to bring on a partner or two partners?

It will be if you have the right structure, the right foundation, the right know how and utilize coaching with starting a business relationship. When you have money, ego and psychology in the game, it’s tough. I have only found it to be easy when the commitment is larger than the individual. If it is about something that is beyond each individual, the answer to your question is, yes. If they are in it for the right reasons: not just to make money, but also to help people, it will be successful.

Take a look at Zappos, Intel and Starbucks. They are about something beyond the individual. They are about making an impact, generating something that leaves a legacy. If dentists can have that kind of character in their game, the transition is much more likely to be successful.

Do you operate like a dental specialist, to show dentists how to get it all together to form a managed group practice?

When I am speaking to a group of solo dentists and developing the idea of future strategies, I ask them, “How much money do you think is in this room?” People look around a bit absently because I’m asking them to consider a bigger picture. But for the purpose of the exercise, most practices generate between $800K-$1.2 million. Then I ask, “How many employees do you think you have?”

With these simple questions I can demonstrate to them that sitting in the room is the foundation for a $20-25 million company with 200 employees. This simple exercise demonstrates the potential they have access to with substantial money and resources behind them. And the collective result that could be accomplished over what the individuals in the room are currently doing.

Describe some of the other resources that are necessary to form a managed group practice.

Solo dental practices as small businesses cannot hire executive talent. They don’t have the money. But in larger groups they can bring on CEOs, CFOs and human resources. They are able to bring in a potency that small businesses cannot. That’s why the larger businesses, like the group practices, are going to gain momentum in the future of dentistry.

What about those dentists sitting around waiting or ignoring the problem? 

Basically, they are blind. Solo practices with their business numbers are decreasing all over the place. I know regular guys who are successful clients in group practices that have figured it out. They understand now that working with ten to twelve to fifteen doctors, with access to larger facilities or a network of locations, they can access the potential and capacity to reach every economy, and get good high-paying executive talent as well. And they can generate the money.

Is insurance a major force that is going to reshape the dental practice? 

Insurance companies are under the same influences as medical insurance companies. The purchaser now is the employer and they want to know what they are getting for their insurance investment. Now they are asking dental insurance companies to give them the same thing, so there’s an influence about results and outcomes that never had to be reported before by dentists to third parties. The influence of these insurance companies is very strong and will only get stronger.

 My passion has always been dentistry and my commitment is focused on how I can enable the members of our dental profession to be successful. My travels have taken me to all 50 states and every major meeting. I am honored to present my interview with one of the true masters of the dental world, Dr. Marc Cooper, founder and president of The Mastery Company. The focus of his company over the past six years has been on group practice of all sizes. 

The current and future state of the solo and group dental practice

	There are many changes in our profession lately; from the types and numbers of procedures we accomplish to the types of continuing education we need, even the way we get products is changing. It is an exciting and unprecedented time in dentistry.

I had the pleasure of discussing these issues with 

, who is a well known practicing prosthodontist in 

. I have known him as a professional and a friend for over 25 years and truly respect his impact on dentistry. The following comments are what he had to say about many of the issues present in our field today and in the years to come.

There are 64 accredited dental schools in the United States. I am amazed that some dental schools closed for various reasons, but then new ones keep opening. What is the reason to keep opening these new schools?

 That is an important question and one on which I appreciate the chance to share my opinion. Many of these are schools are privately owned and are not in a typical university environment. Although many of them are nonprofit, the tuition is extremely high. The reasons for the new schools are very dependent on the entrepreneurial individuals who start them.

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Also, it’s important to look at geographic areas that have the potential need for a dental school. Perhaps they have been waiting for years to start one, and that has never culminated because of the politics in their state. Therefore, the new private school have the opportunity to move in without the political impediments of state politics. Although many of the new schools appear to be financially oriented, many new schools are also altruistically based.

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: Is there a need for these new schools? 

 is a moot point. Some states need new schools, but most of them do not.  In the state of Utah, were I live, there are now two new schools; one is in a university environment, and one is a private school. They will be turning out a very significant amount of dentists soon, but it is well known that this state does not need additional dentists. Other positive aspects of a 

 will have to be emphasized. That is true in many of the states. It is clear that the new schools will dilute the market relative to the numbers of patients for each dentist.

As you know, a typical general practice in the USA has somewhere around 1,800 to 2,000 patients, according to the 

.  When new dentists move into an environment that is already saturated, it will have some negative affects for the established dentists in the area. The fees decrease because there is much more competition and some patients shop for the lowest priced dentist. There is not a need for many new schools at this time, and the new schools will rapidly over-saturate the market significantly in many of the states.

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 The ADA wrote an article in the June 2014 issue of 

about graduating dentists and the debt they have incurred, many of them in the range of $200 to 300 thousand dollars or more. Would you still recommend to young men and women that dentistry is a career that they should pursue?

 I am asked that question very often. I often counsel young dentists, helping them get into dental school. New dentists are coming out of school with 

 estimates higher than you just stated, around $330,000 or more in debt. I have seen some new young dentists coming out at a million dollars in debt, plus the debt that they carried with them before they got into dental school.

When observing the typical current dental school tuition for a private school, and some state schools, most of them have tuition somewhere around $80,000 a year. In addition, they have to have at least $20,000 a year to live, so that means about $100,000 per year for tuition and living expenses. If they go into dental school with some debt already, you can see debt at graduation is a major challenge.

Is that going to be paid back by being a 

? I will be candid again and say, not for several years. I predict it will take a typical young dentist at least five years to get out of debt to the point that they are making enough revenue to feel justified for their years of schooling.

However, I am very strong on my opinion that dentistry is still a fine profession for those who are seeking altruistic service to the public and a 

.  New dentists can eventually make a comfortable income after graduation if they are skilled, but they must go into it with their eyes wide open. If they are married, their spouses should it will take several years of building a practice to become financially stable.

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 If a young dentist came up to you after one of your seminars and said, “Gee, Dr. Christensen, I am really in tough shape here. I don't know what to do. How do you feel about me going into corporate dentistry?”

 Corporate dentistry provides for many dentists the exact kind of a vocational relationship that they desire. Many do not want the worry and hardships of administration of coordinating many employees. They would prefer to start each day at a given time, go home at a given time, and receive a consistent salary.

Many young dentists get out of school incapable of making adequate income without going into 

 Corporate dentistry provides a means for further education past dental school, helping young dentists with building speed and learning techniques that were not taught adequately because of time constraints in dental school.

Overall corporate dentistry has had a bad reputation because of some shady groups that dominated the industry over past years. But there are numerous groups currently trying to overcome that sterotype. I was just speaking for 

University of the Pacific Arthur A. Dugoni School of Dentistry

 recently and I was highly impressed with how they are addressing quality of care and attempting to build the expertise of their young dentists to the level where they are productive as well.

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 It is the largest one; it is an example of one that has been making great efforts to overcome the previously bad reputation of corporate dentistry.  If you want to add another large one, I could say

 Have you done surveys on any of your audiences regarding seeing a drop in income as the 

 Estimates are that gross dentists’ production is up somewhere around 10-12% last year. However, it also estimated that collections are down around 10%. Overhead has slightly increased over the last few years to about 61%, and unfortunately net income is at about the 1998 level. That's frustrating.

Profit per owner is up only slightly. This can be attributed to the fact that many patients have put off needed treatment and, therefore, they have not come in for cleanings or even for rudimentary aspects of dentistry. We think that this will correct itself because waiting too long requires more expensive treatment. Yes, there has been stabilization, of dental income and a reduction of net income for the dentist.

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For a more permanent solution, the word being used is collaboration. This solution would bring three dentists together in a business entity titled managed group practice. What are your thoughts on this arrangement?

 Corporate dentistry allows chief executive officers, and chief financial officers to bargain with dental manufacturers and distributors and to reduce the cost of running a practice. As a result, when corporate groups come to a small community where a private dentist does not have the same opportunity to buy product at a lower cost, the corporate 

There is competition present. Can a group of dentists ban together and essentially be a small group? Of course. Then, they have some bargaining power with distributors and manufacturers, and they can produce dentistry at a lower cost.

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 What advice might you give senior dentists who have not had anybody knocking at their door for associate-ships? Is there anything that you see that a senior dentist might be able to do other than sell out to corporate America?

 I have had nine associates over the many years of my practice when I have needed to have an associate. I have contacted the dental schools in my area and asked the operative dentistry chairperson or fixed 

 chairperson, who were their most competent students. Then we interviewed those students, hired them and brought them into the practice at a moderate income. We allowed them to stay on a temporary basis of one year. Some have stayed longer than that; some have not. Some of them work out very well. I must admit, however, that out of the nine that I have had, only half of them turned out adequately.

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Dr. Doherty: What would you like to say about dentistry ten years from now?

 Let us discuss some of the clinical areas and provide my ideas for you. In 

 we are going to see continued improvement in debridement, better disinfection, and better 

. All three of those areas are somewhat deficient right now. We need a simpler, easier, faster way to do endodontic procedures because this area will continue to grow.

 will begin to dominate, and casts that are digital instead of being handheld stone casts that we have seen in the past will increase. There will be more planning done by computer orientation.

 we are going to see digital impressions begin to dominate soon. I do not think milling in clinical offices will grow rapidly. Milling in labs will be the future. Currently, there is no question that labs without milling machines are going bankrupt. We will see digital impressions sent in, and the milling done in the lab. The next advance in that area will be 

. It is already present in most large labs. I predict this will happen in the next ten years. We see fixed prosthodontic procedures are dominating prosthodontics. Use of metal is rapidly dying, not only due to the cost, but also because of the allergic.

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In oral surgery we are going to see a similar situation as is now present.  Currently, general practitioners are doing the majority of routine oral surgery, with 

 surgeons dominating in other more complex areas.

 will still need major preventive procedures and restorative dentistry, although some countries have reduced the amount of pediatric restorative procedures accomplished for children. That has not been common. Pediatric dentistry will be greatly in need in the United States. There will be more involvement with orthodontics and pediatric dentistry as more pediatric dentists are doing orthodontic procedures.

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 There are many changes in our profession lately; from the types and numbers of procedures we accomplish to the types of continuing education we need, even the way we get products is changing. It is an exciting and unprecedented time in dentistry.