Ed Rabinowitz

Scherer is an advocate for dentists examining their fee schedule on an annual basis, but many do not.

If you want to maximize the sale price of your dental practice, the time to start planning for that is now, or at least three to five years prior to retirement. That will provide enough time and flexibility to get the most for your practice.

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Whether you’re looking to retire in two years or 10, that time will come when you will look to hand the reins of your dental practice to someone else. Well, not just hand them over, but transition by way of selling.

When that time comes, you will want to get as much as you can for your practice. So, it makes sense to start planning now, because it is never too early to plan.

But even as you plan, don’t take your foot off the gas.

“Most dentists, when they get around the age where they want to retire, they slow the practice down,” says Matthew Scherer, president of 

. “And when they cut back, a lot of the time their revenue, their collections, will go down. But their overhead stays the same. So what they end up doing is their practice becomes less profitable.”

But by developing a business or succession plan early on, you can maintain or even increase the value of your practice.

Scherer’s philosophy is to sit down with dentists at least three to five years prior to retirement, at no cost, and discuss their plans for the practice. When do they want to retire? What does retirement look like? What are revenues today, and where do you see them in a few years?

But most importantly, keep the gas pedal down.

“If you were seeing patients four days a week and now you’re only seeing them 2 1/2 days a week, where are those patients going?” Scherer asked. “They’re probably going to the dentist down the street who’s open more hours. And now a potential buyer has to fight to try and re-acquire those patients.”

Potential buyers want to see steady or rising revenue, as do banks. That’s why Scherer recommends sitting down at least three to five years in advance, because banks or buyers want to see practice tax returns for the current and prior three years. By starting early, there is time to right the ship if necessary.

“You have your gross collections, your expenses, and what you bring home — your net,” Scherer says. “The higher the net, the better it looks to a bank and a buyer.”

Scherer is an advocate for dentists examining their fee schedule on an annual basis, something too few do. They see it as a double-edged sword, fearful that if they raise their prices, their patients might leave. But if a dentist examined the average fee for his or her area, the results may prove pretty interesting.

For example, suppose your fees are $40 cheaper than other dentists within a seven- to 10-mile radius. That means you can raise your fees by $20 across the board. If a patient complains about the increase, let them shop around.

“They’re going to find that you’re actually $20 cheaper than everybody else,” Scherer says. “Most older dentists haven’t raised their fees in years, and they’re probably way under what the fee schedule should be.”

If research shows that your fees are right in line with the average for your area, it still makes sense to consider raising them — especially if you haven’t in several years. And if some patients balk?

“If they’re going to squabble over a $10 fee adjustment, then I might be better off losing those patients, raising my fees and still do more, even though I lost a percentage of patients,” Scherer advises.

Often, dentists selling their practice will be reticent to reduce staff salaries because many of them have been with the practice for years, if not decades. They feel a sense of loyalty —but Scherer suggests that loyalty might be misplaced.

“Do you think your front desk person wouldn’t leave the practice if she was offered 50 cents more per hour down the street?” he says. “She’d probably be gone tomorrow. [Lowering salaries] doesn’t mean you’re not loyal to them. But you have a business to run, not a charity.”

Another reason to start planning early is to weigh whether it makes business and economic sense to invest in new dental technology. That does not necessarily mean going out and purchasing a Cerec. You may not do enough crowns to justify it, and a new dentist purchasing the practice may not want it.

But digital X-ray is practically the standard of care today.

“And if you had digital X-ray, you could perhaps slow down but maintain revenue because now you’re more efficient at what you’re doing,” Scherer says. “And not having digital x-ray could decrease the value because it’s something additional the new owner will need to buy.”

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Articles

Though selling your practice may be a long way away, PMA Practice Transitions president Matthew Scherer says putting of plans can hurt the value of your practice. To ease the transition and maintain or even increase the value of your practice, Scherer recommends developing a business or succession plan early on. At least several years prior to retirement is optimal, he said. Learn more about cash flow, managing overhead and examining fees below. 

Plan Early to Increase Your Practice's Sale Value

Leveraging economies of scale, credentialing and more advanced technology are a few of the advantages that accompany treating Medicaid patients. 

Why is it so difficult to make Medicaid dentistry work? That question doesn’t have a simple answer. The challenges are many for the average dental practice. D.M.D Dale Mayfield, chief dental officer at 

, an affiliate of the Atlanta-based Dental Service Organization 

Mayfield spent the better part of a decade working in private practice before joining Kool Smiles. The practice accepted Medicaid patients, but the frequent changes to the program, including changing the managed care organizations that supported it, made it a challenging endeavor.

“It made it difficult for us to get credentialed, or hard for us to potentially get paid,” Mayfield explains. “At times, we would pull away from seeing Medicaid patients because it was just arduous. It was almost like we needed to have our office managers and staff focused on this one small part of our business.”

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While some of the challenges still exist, there are advantages DSOs have that are fleeting for the average dental practice. One of those is leveraging economies of scale —the ability to purchase supplies and lab services for 150 offices versus a private practice.

But there is also the element of credentialing.

“We now have a team here that supports our dentists to get that done,” Mayfield says. “If a dentist comes to work for us, they don’t have to do the legwork and the cost to be able to get credentialed with Medicaid.”

Over the last several years, Mayfield has been part of a credentialing committee that has set up delegated credentialing with many of the payers Kool Smiles works with. They approach payers by offering to do what’s necessary to make sure a dentist can be credentialed within their plans. The end result is that Kool Smiles is able to credential them through its process, as opposed to now spending potentially months waiting for the payer to get around to credentialing the doctor.

“We can do it a little quicker and allow our dentists to start working sooner,” Mayfield says.

Mayfield says some of the additional benefits DSOs can provide relate to the technology and software that enable tailoring to the patients being seen by the Medicaid plans serviced by practice.

“It makes it easier for charting patients, which flows through to the billing,” he explains. “That makes the billing side easier for the doctors who work for us, rather than having them try to set it up and learn how to do it on their own.”

One of the challenges experienced by small practices serving a limited number of Medicaid patients is not being able to make up the lost revenue from cancelled appointments. Kool Smiles, however, has a call center built into a dedicated marketing group that works closely with patients to help them book and reschedule appointments.

“We’ve improved the ability to get patients to return to us by making it easier for them to make appointments, remind them of their appointments and to come in for recall appointments,” Mayfield says.

These efforts add up to improved care quality. According to a multi-state study by 

, Kool Smiles dental providers performed 15 percent fewer services overall, including 40 percent fewer extractions and 39 percent fewer pulpotomies. The study concluded that if all Medicaid dental providers within the seven states adopted the same protocol and utilization rates as Kool Smiles providers, the total savings to state Medicaid programs would exceed $550 million annually.

But Mayfield says the benefits go beyond the numbers.

“Most of the people who come to work for us, dentists included, join us because of the mission aspect of what we do,” he says. “There’s a big part of what we do that is rewarding beyond any sort of financial impact. We’re making a difference. We’re able to now see a population that wasn’t able to be seen, educate parents and take care of the needs of their kids and their future generations.”

Mayfield says whether practicing in a DSO, a private practice or a community health center, dentists should have the ability to make all clinical decisions. The DSO practice support model allows for that.

“Working with the DSO allows dentists to spend more time on patient care,” he says. “Dentists don’t have to do other things outside of patient care time, like worry about staffing, paying the electric bill or ordering supplies. It’s nice to go home and not have to do those other things.”

For individual practices, serving Medicaid patients can be challenging, frustrating and not cost effective. But the economies of scale combined with a wide range of support as part of a DSO can help dentists make a difference. Dale Mayfield, chief dental officer at Kool Smiles, knows how meet those challenges head-on. Read on to learn more about how to make Medicaid work for both you and your patients. 

Navigating Medicaid Dentistry for a Mutually Beneficial Outcome

After a long day at his practice, Dr. Jayesh Patel unwinds by volunteering his services to communities surrounding Waco, Texas. 

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Two-hour round trips each month to perform free oral surgery? Jayesh Patel says he enjoys the drive. What’s more, he thrives on giving back and has built a career on using his skills to help those in need.

Jayesh Patel, D.D.S., F.I.C.O.I., F.A.A.I.P., received his first filling in high school. He spent the first 10 years of his life growing up in England, where he had scarce access to dental care. A light bulb turned on when that first filling was done.

“I thought, ‘this might be something for me,’” Patel recalls. “It’s very hands on, and I love working with my hands.”

That affinity started at a young age. Patel’s mother worked at a leather factory and would bring home leather goods that needed stitching. Helping his mother instilled in him the importance of tactile work.

When he moved to the U.S., his family entered the hospitality business, which meant Patel spent much of his time working, cleaning and preparing rooms for guests. Paying attention to detail was part of the work ethic drilled into him at a young age.

“Anything we ever touched, my parents wanted to make sure that we did it right the first time,” Patel says.

When he made the decision to pursue a career in dentistry, the surgical component caught his attention. Today, that is Patel’s focus at his 

Patel loves serving his community, as well as the surrounding communities, and takes any opportunity to use his skills for the benefit of others. He volunteered with the Belton Body of Christ Community Clinic in Belton, Texas, a 50-minute drive each way, for the past seven years. On the fourth Thursday of each month, after treating patients all day at his private practice, Patel makes the trip to perform gratis oral surgery for those in need.

“I feel very fortunate that I have a gift I’ve learned to use to the best of my ability,” Patel explains. “Why not give that back to the community? There are a lot of people out there who don’t have access to fair dental care.”

The passion to help began during Patel’s sophomore year in dental school, when he signed up to visit a remote village in Mexico. He has volunteered his time ever since, and he says it does not matter how tired he is at the end of his regular workday. Walking into the clinic revitalizes him.

“It’s almost like God has hit the reset button for you,” Patel says. “You walk through the door, and it’s like starting over. Like I just woke up. I feel like I want to see everybody who shows up, and it never feels like a burden.”

That feeling, Patel says, comes from the people he helps, be it at the clinic, his private practice, or those he sees when volunteering for the Texas Mission of Mercy on weekends. Many travel 90 miles for care, living from paycheck to paycheck or on Social Security checks, often counting pennies for the gas required to make the long drive. Some of them save up for months in order to visit his practice.

He also cites his mother, who passed away a couple years ago, as a source of empowerment.

“We all love and praise our mothers,” he says. “But she was just a very special person. What I learned from that woman growing up — everything and anything you can mention I equate to her. Just live life to the fullest and pass it on to my patients.”

Patel began coaching youth basketball a little over a year ago. His youngest sons, ages six and 12, love basketball. When they went out for youth teams in their neighborhood and Patel, a basketball lover in his own right, learned there were openings for coaches, he signed on as well.

“It’s so rewarding to see these kids work with you, look up to you and respect you,” Patel says. “We show them how to have fun, respect one another, and honor the game. For young kids like this, it’s building blocks. They can learn and have fun at the same time.”

For Patel, it is also a way to clear his mind.

“We all love what we do,” he says. “But sometimes we get burned out. You need to take a step aside and do something else. This is my ‘something else.’”

 Patel says much of his volunteering and mission work started by joining local dental societies, which provide a space for dentists to share and learn from each other. Being that the one he belongs to is a large, central chapter that pulls in dentists from about a 100-mile radius, you never know who might walk in the door.

“One day, a dentist who lives in Belton came to one of our meetings,” Patel recalls. “He just started asking, ‘Hey, we’re looking for volunteers. Is anybody interested?’ I emailed him that night when I got home to learn more about it, and I signed up.”

Patel says that in some ways, volunteering becomes an addiction. When he learned the Texas Mission of Mercy was looking for dentists to volunteer for weekend missions held several times a year in remote locations, he jumped at the chance.

 his eldest son often joins him on these mission trips, and his son’s friends are inspired to give back as well.

“They’re intrigued by this,” Patel says. “It’s like a chain reaction, a domino effect, and that’s how it starts.”

Now Patel wants to take his charitable work to the next level. Patel hopes to take his colleagues and family to his parents’ home country, India, to help people without access to dental care.

Discover more Dentist’s Money Digest® news here

Growing up, Texas dentist Jayesh Patel's passion for working with his hands and helping others was sparked by his parents. Now, a father himself, Patel has not forgotten the value of giving back to the community. Armed with his dental tools, an endless supply of energy and an abundance of compassion, you can find Patel offering free dental services to those in need. Read on to learn more about Patel's efforts to make dental care accessible to as many people as he can. 

There are many legal requirements that you need to be aware of before requiring your dental practice employees to clock in and out. 

The difference between “on the clock” and “off the clock” at work may seem self-explanatory where being paid is concerned. However, that is not always the case.

“Anything that’s legal is pretty much not ever going to be clear-cut,” says Shanna Wall, a compliance attorney with the Pompano, Florida-based 

Resulting confusion could be problematic for dentists who require staff, particularly hygienists, to clock out either during break, or when they’re not working on a patient or handling other dental practice-related responsibilities.

Wall explains that when it comes to breaks or who must clock in and out, and why, the focus is on non-exempt employees. They are paid hourly for time spent actively working, versus exempt employees who are being paid a set salary for whatever work they do that week.

Even then, there is still a great deal of misunderstanding because most workers believe they are entitled to breaks. However, there is no federal law requiring break times or meal times.

“Where it gets murky is that individual states may have requirements which need to be followed,” Wall says.

Almost every employer offers a break because it is good for company morale, Wall says. What is required, however, is that if a non-exempt employee takes a break fewer than 15 minutes, they do not have to clock out. With longer breaks, such as a meal break of 25 minutes or more, employers can require they clock out.

Wall adds that employees on break cannot perform any work whatsoever. “They can’t answer a quick email on their lunch break or answer the phones. If they do any work at all, [employers] have to pay them for that time.”

Beyond break time, imagine a patient phones to cancel their hygienist appointment the same morning of the scheduled visit. With little time to fill that open slot, it is possible the hygienist will be sans patients for that hour.

“You’re no longer talking about a break period,” Wall explains. “You’re talking about what constitutes an hour worked. That’s a little bit different.”

If an employee is scheduled at the practice and they are there and willing to work, they must be paid, unless there is a prior arrangement or contract indicating they are paid per appointment. Depending on how the practice is run, that could also be time the worker uses to catch up on paperwork or other practice-related responsibilities.

“If you’re going to have an arrangement with them that you’re not going to pay them anytime there’s a cancellation, then absolutely not. They cannot do any kind of work,” Wall says. “If any work is done or anything is done to benefit the employer, they need to be paid for that.”

Then there is the matter of whether an employee is “engaged to wait,” or “waiting to be engaged”—neither of which has anything to do with planning a wedding. Engaged to wait refers to an employee working under the Fair Labor Standards Act and is therefore entitled to compensation. In contrast, an employee waiting to be engaged is not considered to be working.

Let’s say an employee is scheduled to work 9 a.m. until 5 p.m. and the bus they take to work drops them off at 8:30 a.m. If they are a non-exempt employee paid hourly, they sit at their desk but they cannot work unless they receive authorization. They cannot even start setting up the exam rooms. That employee is “waiting to be engaged.”

Suppose it is after 9 a.m. and a freak storm knocks out the power at the practice. Nobody can do anything because systems are all down. That is not the employee’s fault.

“It’s not like you can require them to clock out,” Wall says. “They’re there, they’re willing to work, and they’re able to work. It’s circumstances beyond their control that are preventing them from working. You’re going to pay them for that time.” That employee is “engaged to wait.”

To avoid problems or misunderstandings, Wall recommends having written policies in place. If you’re hit with a lawsuit because an employee claims they were not paid properly for the hours they worked, those written policies can be used as a defense in a lawsuit.

Communication, Wall adds, as well as properly training managers is very important to ensure everyone understands the policies in place.

“Especially for smaller practice,” she says. “When you don’t pay somebody correctly, you’re opening yourself up to attorney fees which, many times, are double or quadruple the unpaid balance you owe the employee, plus the time to defend a lawsuit. And then you’ve got a real mess.”

Depending on state laws and practice work policies, requiring your dental practice employees to clock out whenever they go on break could be problematic. The legal implications of clock in and clock out times can carry more risks than may appear on the surface. Understanding the ins and outs of employee hours could help avoid costly lawsuits and maintain employee morale. 

	Is mobile dentistry the latest way to provide quality dental care to the aging population in America?

 reports that by 2050, the number of Americans age 65 and older will reach 83.7 million — nearly double the 43.1 million in that category in 2012.

With aging comes a reduced level of mobility, but the need for quality dental care among an aging population remains everpresent. Mobile dentistry is one way the industry is addressing that need.

Wisdom Tooth Mobile Dentistry, a division of 

, has been providing dental services to Rhode Island’s aging population for the past nine years.

CareLink oversees a network of facilities from adult day care and nursing homes to housing and home health. These facilities are required to provide access to dental care, but according to Eric Franklin, director of health services, that requirement wasn’t being met.

Wisdom Tooth Mobile Dentistry was created to fill that gap — but it didn’t necessarily come easy.

On April 1, 2015, a mobile dental law went into effect in Michigan that required an operator or owner of a mobile dental facility to complete an application and be approved by the Michigan Department of Health and Human Services. The law also required the owner/operator to reapply every three years.

In other words, dentists can’t simply outfit a mobile facility and head out on the road. It may be illegal in your state, and it’s also expensive.

“It’s cost prohibitive to (perform mobile dentistry) prior to being approved by the state,” Franklin says. “Through extensive lobbying, the state opened up the opportunity for providers to bid for this type of service. We had to go through a pretty extensive readiness review.”

And after being approved, Wisdom Tooth Mobile Dentistry was able to capture an enhanced rate for services.

“Ninety percent of what we do is through Medicaid,” Franklin adds. “If we weren’t able to capture that enhanced rate, there’s no way we would be able to provide this service.”

, also noticed a gap — a need for dental care among economically disadvantaged schoolchildren. He developed a model to provide much needed dental care for these children at their schools in mobile dental clinics by local dentists during school hours.

But, he first had an image hurdle to clear.

“The biggest challenge I had was turf protection from dentists,” Reese says. “A lot of dentists, especially in smaller towns, didn’t understand what we were doing.”

That was compounded by an image tainted by groups of mobile practices that Reese says were doing “hit and run dentistry” where they were billing for services they didn’t provide, or would not provide any proper follow up.

Working closely with the South Carolina Dental Association, South Carolina Board of Dentistry, Department of Health and Human Services, Department of Social Services, and school district representatives, among others, Reese sought and received positive feedback for his idea. He launched Dental Access Carolina in January 2001, and nine months later sold his brick and mortar practice to concentrate on the new entity full time.

Franklin explains that, in many respects, mobile dentistry is a work in progress. He says there are just over 80 nursing homes in Rhode Island, and Wisdom Tooth is present in 48 of them. It’s goal is to serve the Rhode Island elder population — a niche market approach other entities have taken.

 delivers on-site care to elderly nursing facility residents, disabled adults living in group homes, and low-income children at Head Start centers and schools in parts of Minnesota and California.

. provides on-site dental readiness exams to military personnel in 19 states and American Samoa. And the Smile Center Dental Group ensures dental care for children in schools, group homes, and residential treatment center in parts of Pennsylvania and Washington, D.C.

For dental practices that might be considering a venture into mobile dentistry, Franklin says the key to success is the effort needs to be collaborative. And there needs to be perspective.

“We went into this for public health,” he says. “We went into this to fill a void. And I feel like that’s what we’ve accomplished.”

Reese echoes those thoughts, adding that educating local dentists on what mobile dentistry is and what it does is critical.

“Dentists as a group have a zero-sum mentality,” Reese says. “They think that if you’ve got something, it means you took something from them. They don’t understand that there’s enough for everybody to go around.”

Mobile dentistry isn't just another ancillary service that can be brought into a practice to supplement revenue. It's a commitment–”but when done right, it can be both a clinically and financially rewarding experience.

Mobile Dentistry Helps Fill Important Gaps

To say Sargon Lazarof, D.D.S. experienced culture shock when he came to the United States from Iran in 1975 is an understatement. Lazarof, who was 14 when he immigrated to California to live with an aunt, walked into Hollywood High School on his first day and knew immediately something was wrong.

“I wore a suit and a tie,” Lazarof recalls. “I quickly noticed that I was really out of place.”

When he went to the school cafeteria to order breakfast, he was told it was free. So was lunch. Coming from a small private school in Iran, everything seemed upside-down.

“The school is free,” Lazarof recalls thinking. “The food is free. It was a shock to me. This country accepted me and basically opened all doors to give me my education. Coming to America was a great thing.”

And Lazarof did not waste the opportunity.

, comes from a family of engineers. He thought he might follow in their footsteps until he was presented with Career Opportunity Day while in tenth grade. That’s when he heard a dentist talk about dentistry being a combination of science and art.

“I was always interested in art and music, so it kind of clicked in my head,” Lazarof says. “I volunteered to work in a dental office, and that’s when I fell in love with the whole idea of becoming a dentist.”

Lazarof worked his way through school at the USC School of Dentistry, but not in the usual way. He paid his tuition by using his musical talent on weekends — a far cry from the atmosphere surrounding music back home.

In Iran, musicians were looked down upon. So despite having uncles who played the guitar, Lazarof’s mother attempted to dissuade him from learning the instrument. Nevertheless, the young man found a way.

“I had to secretly steal my uncle’s guitar and teach myself, then put it back in the same position,” Lazarof explains. “If it was slightly moved, I would get punished.”

That stealthy act paid off when he moved to the U.S. While many of his high school friends were getting part-time jobs in places like the supermarket, Lazarof seized an opportunity to join an international band. He began earning good money that enabled him to attend college during the day while playing music at clubs at night.

“When I received my bachelor’s degree I had no loans,” he says. “[The undergraduate degree] was all paid for.”

Lazarof had to tuck music away while dedicating his resources full time to dental school, and later to establishing himself in his field. But today, music is a huge part of his life — both in and out of his dental practice.

Once Lazarof went public with his music, everything clicked. He wrote and performed an original composition, and the reaction was beyond his expectations. He now performs regularly, giving concerts where he plays guitar and piano with an orchestra.

He says he has two worlds that balance each other.

“Dentistry comes with a certain amount of stress,” Lazarof says. “Some people go home and take a drink, or smoke cigarettes. For me, I sit behind an instrument. And as soon as I start playing, start singing, it gives me complete relaxation. It takes me to a completely different world.”

Lazarof says the scientific world in which he lives satisfies one part of him, but music satisfies the artistic side.

“There are two stages that I really enjoy,” he explains. “One is when I’m doing surgeries, when I’m doing demonstrations, and I have all these doctors watching me and learning. The other one is the music stage. When I’m on stage performing and I have different people who are watching, it’s very exciting.”

But there are times when the two worlds meet. Lazarof has a grand piano and guitars in the lobby of his dental practice, and often uses music to help calm patients, some of whom are nervous because they’ve previously had a bad dental experience.

“When they get used to this environment, they feel more at home,” he says. “They feel more relaxed.”

Lazarof’s scientific side is also creative. Shortly after graduating dental school he became interested in dental implants. He began working with them but quickly noticed some of their downside. The main one was the long waiting period.

“I had patients with loose dentures for months coming to my office in pain needing adjustments,” he says. “We put this screw in and we wait for six months for bone to grow and make contact with the screw.”

That’s when everything clicked. Lazarof thought, why not use an expandable screw that can contact bone and lock in faster. Much research and work followed, but in the end Lazarof developed the first FDA-approved immediate load implant, the Ultratooth.

That initiative has today grown into the Sargon Dental & Implant Institute, where dentists can train in both basic and advanced implantology.

Lazarof says the rewards he receives come on an almost daily basis. He’s been doing implant work for 26 years, and whether he’s working with younger patients who have lost teeth, or middle-aged patients experiencing tooth loss, being able to look in their eyes and tell them he can give them a brand new tooth — and see the emotion and excitement they experience—is very rewarding.

“We recently brought in a patient and put her to sleep,” Lazarof recalls. “Three hours later she wakes up and she has brand new teeth in her mouth. Not only did she cry, everybody started to cry. It got really emotional. It’s just the ultimate for dentistry, as far as satisfaction for the patient and the doctor.”

Music is therapeutic, and not just for patients. Sargon Lazarof, D.D.S., says at the end of a stressful day, there's nothing better than strumming his guitar and singing. It helped pay his way to an undergraduate degree, and now it's helping his patients.

Dentist Blends Science and Art to Have Best of Both Worlds

Millennial dentists are especially good at incorporating technology into their practices. 

There are some new kids on the block, and they truly are a hit in their field, though they’re hardly kids.

They’re the next generation of dentists — millennials who have graduated dental school over the last 10 years or so, and they’ve been successful not just buying into practices, but building large, successful practices much faster than their predecessors.

“Building strong, cohesive teams is really the key to practice success,” says Dan Croft, 

head of healthcare practice solutions at TD Bank

. “It’s their team-oriented approach and the embrace of technology that’s the biggest difference between them and the baby boomers.”

, says there’s a parallel between older dentists and businesses like his CPA firm, which he’s been running for 32 years. That parallel is the importance of reinventing oneself.

“We used to get clients by being in the Rotary Club, and the Kiwanis, and doing external marketing with postcards, discount coupons and the Yellow Pages,” Rubin explains. “That’s all changed with the Internet.”

And millennials, who have grown up in today’s technology world, know how to leverage that technology to capture a sizeable market share in a relatively short amount of time. They’re comfortable with technology, and it’s not limited to social media. They’re also investing in the latest technology for their practice, which — despite leaving dental school with significant loans—is enabling them to do more procedures, and do them faster.

“Patients don’t have to come in twice,” Rubin says. “They can come in one day and get same-day crowns. They don’t have to take off of work, fight traffic, sit in the lobby, get numbed up, and do that twice. And that’s very appealing in today’s busy world.”

Croft says these millennial dentists are also much more focused on the importance of the patient experience. That has enabled them to foster greater connections with patients by giving them increased access to healthcare, as well as access to the dentist via email or text.

“Making yourself available is unusual for most doctors, right?” Croft asks, rhetorically. “I think this generation appears to have taken a step back. They accept feedback, and they make changes to their practice.”

Rubin says another distinguishing factor among millennial dentists is they are purchasing the physical location of their practice rather than leasing for 30 years and making someone else rich. In that respect, they’re well positioned with an asset they can sell when they retire.

“The number one investment you can make is in yourself, and your education,” Rubin says. “We’re seeing more young dentists who want to own their location than ever before in southern California.”

And banks, Croft agrees, are much more comfortable lending for tangible assets like cars, buildings and equipment. That’s because the collateral is a tangible asset. The doctor owns the practice and the building. He or she has control, and eliminates any issues that could arise when negotiating a new lease or having to relocate if a new owner decides to increase the rent.

“When you put it all together, and you have the down payment available, generally you’re going to have a decrease in the monthly payments,” Croft says. “So, from a bank’s perspective, as time goes on you’ve got more equity in your practice, you’re paying down your loan, and the practice hopefully is increasing in value. You’re basically creating a valuable asset.”

Croft says that the direction millennial dentists are taking their practices is good for the industry, and he expects the trend to continue—especially since many patients are millennials as well.

“They want instant gratification,” Croft says. “They want accessibility, they want the bet technology, and they want the best communication. So the millennials in general will definitely have a powerful impact on the future design of dental practices, and the services offered.”

Rubin poses a rhetorical question: Is it a good time to be a dentist? He thinks it is, providing you’re taking the proper steps to compete.

The younger dentists, he says, are doing just that. They’re bringing in 50 to 100 new patients every month only six months after opening their practice. And older dentists who don’t adapt — who don’t run their business like a business, encourage online reviews from patients or manage their online reputation—are getting left behind.

“It’s a phenomenal time to be a dentist,” Rubin says. “But you have to be doing everything, or enough things, right.”

Millennial dentists are growing up quickly and changing the face of the industry. With a focus on technology and patient experiences, they've issued a challenge to older more established dentists: Adapt, or get left behind.

Millennial Dentists are Blazing New Pathways

When you want to pay bills and the balance in your checkbook is zero, that’s not a good thing. But, ideally, that’s exactly your accounts receivable balance should be. Zero.

Meaning, you’re collecting 100 percent of what you’re billing. It can happen, but not without some forethought and preparation. And that starts with setting goals.

But according to Kerry Straine, a certified professional behavioral and values analyst, and president of 

, the majority of dentists do not set production or collection goals.

“Establishing goals for accounts receivable is critical, because it's a byproduct of uncollected production,” explains Straine. “An account that we’re waiting to receive is representative of work the practice has expended overhead for. So for a small business owner like a dentist, they’ve got to have a clear understanding of ‘what are my collection goals going to be?’”

Having the right staff in the right seats is vital to the success of a dental practice. And now just economic success, Straine says, but the success of building a culture that allows employees to feel like they’re making a contribution, and being recognized for that performance. That performance includes achieving set goals.

April Brissette is the chief lending officer with 

, a leading provider of financial solutions to healthcare professionals. She agrees that goal setting and staff go hand in hand.

Brissette explains that too often dentists don’t have control over their accounts receivable because they’ve put that responsibility in the hands of someone that don’t know well and don’t necessarily trust. That could be the front desk person who’s being paid $12 an hour, yet holds the key to your finances because they’re controlling how much money is coming back into the practice.

“Whether you’re setting a numerical goal of how much you’re going to collect each month, or making sure you have the right person in the right seat, goals are of the utmost importance in terms of accounts receivable,” Brissette says.

Sending claims out daily sounds like a no-brainer concept because it allows for constant cash flow rather than large sums coming in here and there. But Brissette says that too often practices will send their claims out once a week, such as on Friday morning. But if a service was performed the previous Friday afternoon or earlier that week on Monday morning, you’ve now built in a one-week lag time in getting the claim to the insurance company.

“And then, if there’s a kickback because the coding is wrong or something is incorrect, then it could be months before you get reimbursed for that,” Brissette says. “So while it might seem a little cumbersome to do it daily … figuring out a way to send them out daily is ideal for cash flow.”

Straine, an advocate of sending out insurance claims daily and collecting co-payments at the time of treatment, is also a golfer. In years passed when he’s had a chance to golf with friends, a wager or two would often be placed. In that vein, the old saying comes to mind: “Fast pay makes fast friends.”

“Don’t let money get between you and a friend,” Straine explains. “Certainly, don’t let it get between you and a customer. And the longer the insurance claim goes without being paid, the less certain we’ll have enough cash flow to maintain operations.”

Straine says that when it comes to maximizing accounts receivable, it makes sense to offer patients as many options to finance their out-of-pocket expense as possible. For example, his consulting firm has been a fan of CareCredit for 20 years. And when he sees a downward trend of fewer transactions being processed through CareCredit, there’s usually a correlation between that and lower production.

“Over the last 50 years America has been built on how much you can afford to pay monthly, not how much is the cost of the product,” Straine says. “It has been programmed into us that credit is an acceptable way to finance the joy of life. And the joy of life is being healthy.”

Brissete echoes those thoughts. She says that Bankers Healthcare Group's clients often sees patients declining treatment plans because they lack the means to pay for it, yet they don’t necessarily want to admit that to the dentist. Those are missed opportunities.

“There could be a lot of collections out there if [patient financing] was an option for patients,” she says.

Are you sending out claims daily? Do you have the right people in the right seats? Those might seem like simple questions, but unless your answer is 'Yes' to both, you may not be maximizing your accounts receivable collections.