Ed Rabinowitz

A goal without a plan is just a wish. That’s a famous quote from French writer Antoine de Saint-Exupery. And even though the quote dates back to the first half of the 20

 century, it’s perfectly applicable today to many aspects of life.

One of those aspects is the separation that exists between an average dental practice and one that is more successful financially. It’s about planning—specifically, having a strategic action plan. Unfortunately, that plan is missing from too many dental practices.

“In the dental field, 85-90% of dentists coming out of dental school, within two to four years are either off on their own, or buy into some sort of practice,” says Mark Balog, CPA, principal with Balog & Associate, CPAs, PLLC. “They’re good technicians at the end of the day, but they’re not equipped to run a practice.”

And developing that strategic action plan is key to achieving financial success.

Balog says that financially successful dentists clearly define their one, three, and five-year goals. They recognize that their dental practice is the vehicle that will enable them to achieve their goals. And then they start by working backwards.

For example, a young dentist who recently bought into an existing practice or started one from scratch may have designs on owning a home within the next three years. Doing so may require a down payment of $150,000. By working backwards, the dentist can map out a plan for how much he or she needs to save each year to achieve that $150,000 figure, and how that savings will be accrued.

“How many patients do I need to see on an annual, monthly, weekly, or daily basis to make that happen?” says Balog of the planning strategy. “Each successful dentist breaks out their revenue streams, such as the simple cleanings, implants, cosmetics, and root canals.”

They also dig a little deeper. If they take insurance, which insurers are going to pay them the best fees with respect to the type of procedures they’re going to do.

“If I know that, I’m able to now advertise or hone in my advertising accordingly to attract the right traffic or footprints to generate that extra business,” Balog says.

He also points out that financially successful dentists recognize the difference between the practice of dentistry—applying the technical skills learned during dental school—and the business of dentistry, which is learning how to monetize that technical skill set.

Balog believes that financially successful dentists know what they know, and know what they 

 know. They realize that they need to surround themselves with the proper team and talent, both internally and externally.

“You’re as good as your team,” he says. “You need to put in policies and procedures to share the wealth. If the dentist is making money, everyone should be making money. As long as you hold everyone accountable and establish certain yardsticks to make measurable, achievable goals for everyone, it’s a mutually beneficial exchange.”

On the external side, Balog advises dentists to obtain the services of a healthcare attorney, a healthcare CPA, and a healthcare financial planner. At the end of the day, he says, there are nuances between servicing a dental practice versus other businesses.

“Unfortunately, sometimes dentists feel like they’re capable of doing payroll, for example,” he says. “It’s a non value-added service. Farm it out. Your time is worth more than you trying to figure out payroll.”

Balog says that as part of having a strategic action plan, dentists need to create a GPS or customized dashboard to monitor and measure their progress. Benchmarks and key performance indicators, he says, are like looking at a car’s fuel tank. They help you know whether you’re half full or running on empty.

“With any successful dental practice it’s all about monitoring the cash flow,” Balog says. “We want to know what the average production/net collections are that the dentist makes per hour, what the hygienist makes per hour, what does that add up to collectively. What does the average patient bring in per year, and what do you consider an active versus an inactive patient?”

Just how important are these key performance indicators? Balog says that if the practice brings in, on average, $120,000 a month of net collections, and one month it goes up to $150,000, you’ll want to know what you did differently that month so that you can replicate it on a monthly basis. Similarly, if net collections dropped by $30,000, you’ll want to make sure you don’t repeat that problem.

“With all these practice management software programs, you’ve got certain key performance reports at your fingertips,” he says. “You have to keep your finger on the pulse. At the end of the day there’s no management without measurement.”

Articles

Dentists enter their careers with wide capabilities in oral healthcare, but with relatively little in the way of business know-how. These tips will help ensure the business side of your practice is equally successful.

How to Ace the Business Side of Your Practice

Recruiting new customers is no small task. Consider the plight of car dealerships. According to statistics from R.L. Polk Company, the average car on American roads is now close to 11 years old. And J.D. Power and Associates reports that the average trade-in at new-car dealerships is now 6.5 years old.

So, it’s critical for car dealerships to cultivate relationships with new customers.

The same is true for dentists and new patients.

“You always have to get new mouths in the door or your practice is going to shrivel up,” says Daniel Greenstein, DDS, with 

, in Boca Raton, FL. “Aside from the recall for hygiene, which financially isn’t a high-ticket item, once you’ve done the dentistry on someone they don’t need more for quite a while.”

To address that dilemma, Greenstein and his colleagues have employed some traditional and some not-so-traditional strategies.

Greenstein is a most gregarious individual. He’s active in the community, and routinely dispenses his business card. He even leaves his card when paying the bill at a local restaurant.

“From an internal marketing perspective, it’s important to make sure your staff is promoting you,” he says.

That means referring their family and friends. Asking satisfied patients to write online reviews, or providing them with several business cards to distribute.

“There’s a Starbucks right here in our plaza,” Greenstein explains. “When my staff goes there, they’ll give a card to the people who wait on them. We try to make sure [our staff] are ambassadors and help spread the word.”

He and his staff routinely ask new patients how they learned about the practice so that the practice may thank the individual who provided the referral. But Greenstein also acknowledges more can be done in this area.

“Before the Internet and social media, back in the days when yellow pages, mailers and coupons were the only way to meet new patients, we had three phone lines and one of them became our marketing line,” he says. “Whenever that line rang, we knew it came from the yellow pages ad or a coupon. But today we should be better at keeping track of where new patients come from.”

In real estate, everything is about location. That’s one of the challenges Mizner Park Dental also faces. The practice is located on the third floor of an upscale shopping plaza with no signage above the shops.

“We’re buried upstairs,” Greenstein says. “I’ve bugged [the landlord] for years to give us a sign; even a little sign in the elevator, and they won’t. It makes me crazy.”

Crazy like a fox, that is. Greenstein and his colleague have a marketing car; a Fiat that is wrapped with the practice’s logo and phone number, and they take turns driving it around town.

“We try to park it in front of Starbucks, because there’s a lot of traffic there.”

, which he doesn’t specifically use to promote himself as a dentist, but the residual benefits are clear.

Back in the early 1990s, local restaurants and bars would put up a microphone one night a week and call themselves a comedy club. Greenstein began doing comedy bits making fun of dentists, insurers, and the like, and one day he was spotted by staff from America’s Funniest People television show.

“They wanted to film me,” he recalls. “I came in second and won $5,000. They had a public relations team, and that got me press locally.”

Greenstein went on to win a local fundraising event for multiple sclerosis called Boca’s Got Talent, and that earned him even more publicity. He has since been on National Public Radio, entertains at dental meetings around the country, and finished second in a contest promoted by Colgate called America’s Funniest Dentist.

“It’s an unorthodox way to meet new patients,” he says. “I often mention my phone number during my act—in English, Spanish and French.”

Mizner Park Dental also engages in a wide range of traditional methods of recruiting new patients, including renting booths at local health fairs and community events, and having staff on hand to distribute small handouts, talk about teeth whitening, and engage the community.

“You have to have staff behind you,” Greenstein says. “We attend these events maybe twice a year. Sometimes they’re great, and sometimes they’re a dud. But two years later a new patient might come in, and when I ask how they heard about us, they say they still had the card from our booth at the health fair. So, you never know.”

Recruiting new customers is no small task. One Florida dentist meets the challenge by using a mix of tried-and-true and out-of-the-box marketing methods.

Recruiting New Patients Via Traditional and Non-Traditional Means

Two of New York City’s leading dentists have been practicing together for more than 10 years.

That may not sound like much of an accomplishment, but then consider that Keith Arbeitman, DDS, and Angelika Shein, DDS, are also husband and wife. More importantly, their relationship dates all the way back to high school.

“The marriage partnership came long before there was any sort of professional direction,” Arbeitman says, laughing.

It does, however, create for interesting chemistry at home.

“If anything, sometimes you want to get away; you want to have someone to come home to and get away from your job,” Shein says. “We don’t really get that as much. We may get a little more overworked than the average couple, but it hasn’t been much of an issue.”

Shein has been interested in science since she was a child, and always enjoyed being creative and working with her hands. She calls it the artist outlet. Arbeitman is no different. Science took him in the medical direction, and dentistry gave him the freedom that can sometimes get lost when working in a hospital.

But even though their personal and professional goals have meshed nicely, they both recognize the importance of periodically turning off the professional side.

“We make an effort to get as far away as possible, as often as possible,” Arbeitman explains. “We have young children, and our weekends are completely dedicated to them and their various athletic endeavors. So that offers a good escape. And we have certain times of the year where we know we’re going to get away, and those are the times that we really cherish.”

On the opposite end of the spectrum, Shein says there are many benefits to working together.

“We always have someone else who understands what we’re going through, which is a huge advantage,” she says. “And we always give each other honest opinions.”

Two years ago, recognizing a change in the complexity and volume of dental emergencies among residents in assisted and skilled nursing communities, Arbeitman and Shein launched 

, a company that provides on-site oral dental services to residents of those communities.

“We were at a point in our career where we were wondering what else was out there,” Arbeitman recalls. “We had a successful practice, but there were other interests that we wanted to pursue. We began thinking on a large scale that there might be a need for dental services in assisted living. And we were right.”

It began almost as an experiment with five facilities, has grown steadily to 20, and will probably reach 30 facilities by the end of 2015. And as Baby Boomers age into assisted living and nursing facilities, the need is likely to increase.

“It’s been a lot of fun, but it’s also been a lot of work, starting up a small business when you already have an existing small- or medium-sized business that keeps you busy from 9 to 5 every day,” Arbeitman says. “But that’s actually been part of the excitement for us. It’s a worthwhile endeavor, and how do we make it happen? How can we rise to that challenge?”

Arbeitman says that he and his wife think of themselves as entrepreneurs as well as dentists.

“We always keep our ears open for any opportunity.”

But the bottom line is dentistry and the care they provide.

“Everything we do has to be grounded in business principles,” he says. “You can’t turn a blind eye to what it costs to run a business. We’re in Manhattan. Whatever it costs to run a business, it's magnified in a city like New York. The two questions we asked ourselves at the start were: can we be efficient and cost effective; and at the same time provide a much needed service?”

The service is definitely needed. Patients needing a dentist rarely have their problems solved in a single visit. For individuals in an assisted living community, that means multiple trips to a dentist. But if the dentist comes to them, it’s a value-added that the patient and their family greatly appreciates.

“We’re dentists,” Shein says. “We want to help people. But we’re business people, too.”

Shein laughs when asked how she and her husband like to spend their free time.

“You know how they say your forties are the rush hour of life?” she asks, rhetorically. “Well, that’s kind of how we feel.”

Shein works part-time at the couple’s practice, so when she’s not there and the kids are in school she enjoys spending time with friends, playing tennis, and exercising. Jogging in Central Park and reading help her to get away.

“We’re not golfers,” Arbeitman adds. “There’s no time in our lives for that right now. But the goal is for there to be time for that at some point.”

For now they’re family oriented. Their two children, ages 10 and 8, take up much of their time.

“And they’re not going to be that age for very long,” Arbeitman adds, “so we try not to do too many things outside of work that would take us away from them.”

Arbeitman says he and his wife have a great deal of pride in the practice they’ve built, and that they’ve done so during difficult economic times.

“We have a wonderful team of people that we work with,” he says. “We have people that have been with us for five, seven, 10 years. We’re very proud of the relationships we have with the people that we are surrounded by. And that’s something that our patients feel also. So I guess it comes full circle.”

He also feels very fortunate with the type of practice they’ve been able to build; one that 

focuses on aesthetic and restorative dentistry

“There’s virtually no insurance meddling or dictating how we treat people,” he says. “There’s a lot of luck that comes with that.”

A pair of New York City dentists share a practice, a startup, and a family. The couple says the partnership is hectic, but rewarding.

Partners in Dentistry, and Life

The level of disclosure that comes from J. Michael Ray, DDS, MPH is unexpected, but reveals the down-to-earth nature of this oral and maxillofacial surgeon.

“I’m not your typical anything that you’re going to run across,” he says. “If you want an oddball, you’ve got me.”

Odd, maybe, but if being odd equates to being successful and interesting, then so be it.

 in Dallas, TX, Ray holds a faculty appointment at the Harvard School of Dental Medicine where he plays an active role in developing global health curriculum for Harvard. But if not for some advice he received in college, that might not be the case.

As a child, Ray had his sights set on becoming a family practice physician. But when he got to college, he met several physicians who changed his way of thinking.

“They felt that they were really working for insurance companies rather than for themselves or for their patients,” Ray explains. “They had to see so many patients during the day just to make ends meet.”

The physicians explained that the reasons they became family practice physicians were the same that Ray had. You get to know your patients, you get to know your patients’ families, and you develop relationships with them over the years. But in an age when patients frequently change insurance plans, that doesn't really happen anymore.

“They said that all of their friends who were dentists have the ability to get to know their patients, to get to know their patients’ families,” Ray says. “They do develop relationships, they don’t work for insurance companies. So if that’s the thing that drew me into medicine, I should look at dentistry instead. And they were right.”

Ray recently took a year off and went to Harvard to obtain his Masters in Public Health. His reason for doing so, he says, was the global health aspect of public health that he found fascinating.

“I first experienced it when I was in the military,” says Ray, who served in the US Navy from 1999-2010, and is currently a commander in the U.S. Navy Reserves. “I traveled a lot, went to a lot of countries seeing patients and while some of them were pretty interesting places, there were also some pretty awful places. But I began to see a worldwide need for quality dentistry and quality dentists.”

Ray’s opportunity to help address that need came while obtaining his MPH. He learned of a project that had been in the works for several years. The Ministry of Health in Rwanda was determined to improve the country’s healthcare system. Part of that initiative included opening the country’s first school of dentistry. With assistance from the Clinton Foundation, the Clinton Health Initiatives, and a multitude of US health-related institutions, the project is nearing fruition.

“This is a big project,” Ray says. “I am a small part of it.”

Small, maybe, but no less important. Ray is involved in curriculum development in oral surgery and clinical competency. He says the curriculum he has designed together with input from faculty members in Rwanda is very exciting, though it’s still in the beginning stages.

“It’s wonderful to work with people in other countries, from other cultures for the same goals as you have, which is to improve the healthcare of their country, including oral health,” Ray says. “The actual tangible benefit hasn’t been seen yet, but it’s exciting to be there in the early stages.”

Ray finished dental school in 1999 and went directly into the Navy. It was there that he applied for residency training in oral and maxillofacial surgery. He was selected and was sent to a civilian hospital for his residency training. But what he saw and experienced during his naval travels—which included four years of sea duty—had the greatest impact on his professional career.

“I was stationed in some great places, but I also saw some pretty awful things,” he recalls. “I was deployed on the USS Comfort. That’s a hospital ship that went down to Haiti after the earthquake five years ago. I treated facial trauma day-in and day-out there. And then about a year and a half after that I went to Afghanistan treating facial trauma patients there as well. And everything that I did in my practice in the navy made me so much better when it comes to practice in the civilian world.”

How so? Ray says it was the depth of the experience he received. The injuries he treated were horrific—the type not often seen in the civilian world. As such, he’s better equipped to handle those situations when they do come up.

Ray, who is 42, single, and lives in Dallas, says he enjoys golf, playing tennis, and travelling both domestically and internationally. He also says it’s very rewarding being involved in the work that the Harvard School of Dental Medicine does.

“Harvard has a lot of money, and I really believe they spent it in the right place, and on the right things,” he says. Then he laughs. “And that’s coming from a southern Republican. But it’s really an honor that they saw enough in me and believed in me and the work that I do to include me in part of their project.”

Closer to home, Ray says what he likes most about his job is the ability to make a significant and lasting impact on the quality of a patient’s health.

“Too many people don’t realize that dentistry is healthcare,” he says. “It’s a big aspect of healthcare, just like any other system in the body. Too many people look at it as elective work that, ‘Oh, I need to get it done, but I also need to get my car fixed,’ but it truly is healthcare So being able to make a lasting and meaningful impact in someone’s health is probably the best part of it for me.”

A Dallas oral surgeon is making an impact far beyond his practice and his city. He's become an influential advocate for global healthcare initiatives. 

Oral Surgeon Makes Impact on Global Health

For most of his career, Gordon Christensen, DDS, MSD, PhD, 

, has been a proponent of expanding the clinical responsibilities of dental assistants, hygienists, and technicians under dental supervision.

The term often used to categorize those dental professionals as midlevel practitioner, though much more in an unofficial rather than official capacity. That’s because only two states, Minnesota and Maine, have officially embraced this new category. And according to Christensen, confusion reigns in those states.

“They have these unknown auxiliaries and they don’t know what to do with them,” he says. “Where do they fit in? What are they paid? Are they paid similar to a dentist, or to a hygienist? It’s not clear.”

And therein lies Christensen’s frustration.

Christensen explains that dental hygienists have been around for 70 or 80 years. Use of dental assistants and laboratory technicians is also widespread. All three of those categories have different kinds of expanded clinical functions that they can do legally—depending on the state.

“And the spread of how liberal a state is, is unbelievably wide,” Christensen says. “In some states you practically have to have a PhD to do anything, and other states are wide open.”

In other words, a ball of confusion. And what’s adding to the confusion, Christensen says, is a lack of vision and leadership.

“I sat with the leadership in Minnesota a year ago and asked what are you doing with these [midlevel dental practitioners]?” he recalls. “They have them, but they don’t know what to do with them.”

What politicians are doing, or want to do, Christensen says, is move these auxiliary dental professionals into geographic areas of need. But he points out that those locations are populated with the most extreme kind of patients: those with the most extreme level of neglect.

“Sticking a midlevel person, who had half the knowledge or a quarter of the knowledge, in these areas makes absolutely no sense to me,” Christensen says. “You must send a dentist there to supervise.”

Christensen says that, almost without exception, the concept of expanding the clinical responsibilities of dental assistants, hygienists and technicians has been successful—for patients, dentists, and dental staff members. And yet there is considerable resistance up and down the industry.

According to Christensen, the American Dental Association and the American Student Dental Association have both been negative on the concept of midlevel dental practitioners. And that negativity has more than trickled down to state leadership.

For example, at a recent meeting in Vermont, Christensen presented 18 expanded functions for already identified and current dental staff that translates into 25 methods of increasing practice productivity. He says it was “interesting” to see how few were ready to jump on the bandwagon.

“They’re in a rut, and they want to stay in a rut,” he explains. “That’s the level of resistance that you see.”

The other major issue, Christensen says, is lack of education. He says that young dentists come out of school having never been taught how to use an assistant.

“Many years ago I got federal grants to bring in an assistant for every senior dental student,” he says. “Today, I doubt there’s a school in this nation that has any program to educate dentists on how to use an assistant.”

And with average dental school debt ranging between $300,000 and $350,000, Christensen believes that being educated on how to use expanded staff functions would not only help these graduates overcome the negativism they feel, but be more productive in their respective practices.

But the education challenge isn’t limited to new dentists.

“You ask older guys to have a dental assistant do something and they flip out,” Christensen says. “There are all kinds of challenges. Some financial, and some educational.”

Christensen says what’s needed to clear up this confusion is a group of real world people.

“Not the Pew Research Center,” he says. “I respect them, but they’re usually academics or administrators, not people on the firing lines.”

He advocates for a more holistic approach—academics teamed with real world practitioners as well as administrators and public health professionals.

“Let’s get this group together, and get some equitable solution rather than have the politicians dominate the people who are actually doing the work,” Christensen says. “There’s nothing wrong with expanding the functions of staff. As I said, I’m the most liberal one in the country. However, not in the way they want to do it, through political channels. Let’s get them out in the field and work a day rather than sit at a desk and prognosticate.”

Dental assistants, hygienists, and technicians have been around for decades, but the terms used to categorize them and the regulations limiting what they can and can't do vary greatly by state.