Ed Rabinowitz

To Cortes, it’s “shockingly wonderful” to see patients experience growth, and a change in lifestyle that gives them more confidence.

A career in dentistry was never part of her strategy. Biochemistry was her focus, building on the graduate work she had done on opioid receptors. But while finishing her master’s at NYU Medical Center, a female doctor noticed her hands.

“We’re really amazed at your hands,” Martha Cortes, DDS, recalls being told. “You have such dexterity. You should be a dentist.”

That set the ball in motion. And a short while later, while interning with Barry Grayson, DDS, in orthodontics and dentofacial orthopedics at NYU Medical Center, she encountered a young woman at a clinic suffering from congenital craniofacial abnormality who had already experienced multiple surgeries.

“She literally looked like her face was sunken in,” Cortes remembers. “She would never smile, never look at your eyes.”

Several months later, a transformation had taken place. The woman was smiling.

“All I could think of was, I’d love to be doing this,” Cortes says. “To help people get confidence, like sunshine radiating from their face.”

Today, Cortes is a general dentist and a dental-sleep medicine expert who operates 

 in New York City. She is also the founder of 

 and has become a leading dentist in treating sleep apnea and other breathing related disorders.

“I have some physicians for patients,” she says. “We’re remodeling their airway, which is really interesting. And it has to do with realizing that it’s not just dental. Medicine needed a wake-up call.”

Cortes and her team work to help patients achieve a cure by developing the bones and soft tissue around the airway. The process involves non-surgical airway remodeling devices patients wear at night, and some light aligners worn during the day. And a key component is orofacial myofunctional/exercise therapy.

“It trains the tongue, it trains the lips, it trains the muscles and it changes the way you swallow,” Cortes explains. “In children, if you put in these appliances, I guarantee that in two weeks they will not be bedwetting every night. Because a symptom of children’s sleep apnea is bedwetting.”

Cortes defines sleep fitness as a lifestyle. She says it’s about creating a “clean mouth” in order to develop a “good elementary canal.” To be more exact, she compares it in some ways to eating organic foods, exercising or yoga meditation. It’s a choice.

“I am witnessing so many children who literally cannot stand straight,” she says. “They have crushed chests. Some of those kids can’t go to regular school because they don’t do well socializing. But three to six months of expansion with these orthotics improved their attitude toward learning, working and they had more energy. And it’s because we treated their airway.”

Cortes says it’s “shockingly wonderful” to see patients experience growth, and a change in lifestyle that gives them more confidence. But it’s also about improved health.

“It’s unbelievable, whether it’s kids or adults,” she says.

One patient recalls that 20 years ago Cortes put veneer on his teeth that had some imperfections since childhood. He has since moved away from New York and notes that the dentists wherever he has lived were “awed” when they discovered that what they saw was not the real surface of his teeth.

More recently, Cortes says that one patient previous to treatment was described as being irritable and hot-tempered. Now, he’s calmer and losing weight. He even recognized that he wasn’t as irritable.

“That’s good,” Cortes told him. “You’re getting oxygen. If you were a little kid and if you were hyper, you would be calming down and doing your homework better. It would be easier.”

Cortes is extremely dedicated, but she does have a life away from her practice. One of her favorite activities, though she acknowledges she’s only able to do it every three to five years, is skiing in Colorado.

“I almost made it this year,” she laughs, “but they didn’t have enough snow.”

She also enjoys biking, canoeing and kayaking, but also loves reading and studying.

“I will never get over being a real nerd,” she says. “Two or three days of the week I wake up at 4 a.m. to study for about two hours. Either I’m reading, studying or writing two or three times a week. You have to know who you are.”

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Martha Cortes, DDS, is a unique and advanced dentist who owns and operates Sleep Fitness LLC, which takes a holistic approach to oral treatment. But her dental career almost never happened due to a little thing called biochemistry. Fortunately, she took a detour along the way.

General Dentist Makes Inroads Treating Sleep Apnea

There are steps a dental practice could take to avoid liability; to avoid legal responsibility for that supervisor’s actions.

Pick any day of the week, log in to CNN online or any other news source, and you’re likely to find a story about alleged sexual harassment. It’s everywhere. And the proliferation of these allegations begs the question, is sexual harassment more prevalent today, or are more people less tolerant and coming forward than they did 15 or 20 years ago?

Stephanie Davis, Esq., S.P.H.R., president of 

, a human resources and employment law consulting firm, thinks it’s the latter. People are feeling empowered to speak up, and the result has been a tidal wave of collective empowerment.

“I definitely don’t think it happened any less in the past,” Davis says. “It was just more accepted as something you had to deal with.”

Davis explains that there are essentially two types of harassment under the law: quid pro quo harassment, and hostile work environment. The former Latin meaning a favor for a favor, and is the “most serious type of harassment.” So where sexual harassment is concerned, it means a sexual or romantic favor in exchange for a job benefit.

“By definition, quid pro quo harassment involves somebody with power, and it involves sex,” Davis explains. “You have sex with me, and I’ll put in a good word for you for that promotion. It has to be somebody who has power over you.”

If a manager or supervisor, someone with power over another individual, engages in quid pro quo harassment and the company is sued, the company is likely to be held responsible for the behavior because there’s strict liability.

“Your managers and supervisors should know better, and you’re being held responsible vicariously for their actions,” Davis says.

The second type of harassment, hostile work environment, is defined as offensive, unwelcome, severe or pervasive behavior based on the protected characteristics of religion, age, disability, race or sex. It must be a demonstration of behavior that an individual is subjected to that they don’t want, don’t like, and is serious or happening frequently. And if it’s a supervisor who is creating the hostile working environment, the organization can again be held responsible.

However, there are steps a dental practice could take to avoid liability; to avoid legal responsibility for that supervisor’s actions.

Keith Gutstein, a partner and co-chair of the labor and employment practice at 

, says it’s essential that the practice maintains an updated policy stating that discrimination and harassment are prohibited, and that there is a clear and easy-to-use complaint procedure making it simple for someone to file an internal complaint. Also, make certain there is a policy against retaliation.

Davis agrees, and stresses that the policy specifically apply to the dental practice workplace.

“Every workplace is unique,” she says. “You’ve got people working in close quarters. Maybe they’ve worked together for many years and have some familiarity with one another. So you want to have a carefully drafted policy.”

But a policy is worth nothing if people don’t understand it, Davis cautions. As such, it’s imperative to train staff with regard to the policy. And make certain a process is in place for comfortably bringing forward the concerns.

“Make sure everybody knows that if they have concerns, it’s totally okay to bring it to somebody’s attention,” she says. “And just as with any other leader, it’s critical for the dentist to model the behavior addressed in the policy.”

If a dental practice has been negligent in establishing firm policies, procedures and training, the practice can be held responsible for an individual’s actions. Depending on the jurisdiction, Davis says, a practice can be named as a defendant just as an individual can.

“The practice can be held liable for negligence even if it’s not negligent,” Davis explains. “The practice can have a great policy, training, and an investigation process, but if one of its leaders decides to engage in quid pro quo sexual harassment, it doesn’t matter. The practice will be held responsible because it’s strict liability.”

Davis stresses the importance of everyone at the practice coming together collectively for interactive training sessions to understand where the boundaries are. Because boundaries are invisible, and they change depending on people’s moods.

“Avoid inflammatory topics,” Davis suggests. “If you tell sex jokes, you’re probably going to cross somebody’s boundary at some point. It’s risky behavior. And when you do cross someone’s boundary, because ultimately everyone messes up, own the behavior and apologize.”

Imagine talking to colleagues during a lunch break and telling an off-color joke. It might seem harmless to you, but it might be offensive to somebody else. Respect for people's boundaries, and understanding what constitutes sexual harassment can help avoid costly litigation and create a work culture that addresses everyone's comfort level.

Interactive Training Helps Avoid Sexual Harassment Claims

	Are more dental practices filing insurance claims? Alvarez says it depends on the geographic location of the practice. 

At the start of 2018, the American Dental Association added 18 new codes and deleted three others from the 

. Is your staff current with these changes? If not, it could mean lost revenue for your dental practice.

“It comes down to production, and making a profit,” says Nicole Alvarez, program director at 

, and a member of the California Association of Dental Assistant Teachers.

Alvarez explains that if the staff member responsible for billing is not up-to-date on codes, one of two things is going to happen. The practice will not get paid, or it will get paid an old fee for the previous year, and that can hurt.

“So, it all comes down to the bottom line,” she emphasizes, “and production.”

Alvarez says it’s critical that practices have billing staff attend training sessions on billing and coding so they are well versed in all the latest changes. Most colleges that offer medical billing and coding training also have an in-depth module on dental codes. Who should be trained?

“For sure the office manager, if the office manager is in charge of billing,” Alvarez says. “If the practice has an office manager who’s more administrative and has a delegated person for billing, then that’s the individual who needs to know. The back office dental assistant would need to have entry-level knowledge in case the office manager is out ill.”

But understanding codes is more than just memorizing numbers, Alvarez stresses. It’s important to understand coverage and cross coding because there are different codes that can be used for multiple procedures.

For example, Alvarez recalls working for a general dentist who specialized in treating disorders of the temporomandibular joint. As such, he saw many patients for trigger point injections, making mouthpieces that would ease the pressure on their jaw.

“A lot of that went through medical insurance,” she says.

A colleague of the dentist where Alvarez was employed see patients for sleep apnea and would make appliances to help open the patient’s airway and alleviate their snoring.

“That crosses over from medical as well.”

Are more dental practices filing insurance claims? Alvarez says it depends on the geographic location of the practice. For example, in a small town like Bakersfield, California, which is her hometown, virtually every dental practice uses insurance. However, in larger cities where there are more high-end practices doing large restorative cases, there’s less desire to operate on an insurance schedule.

“They tell patients, ‘We’ll do the work, you pay us cash, and then you can bill your insurance for the reimbursement,’” Alvarez says. “They kind of put it on the patient.”

Many practices in the Los Angeles area do the same, she says. They don’t want to deal with insurance; don’t want anyone telling them what they can charge for certain procedures. So the patient pays up front and is provided with all the information they need to bill their insurance company for reimbursement.

“It really just depends on the market and the location,” she says.

Alvarez believes it’s important for all dentists to encourage their staff to attend training sessions and stay up-to-date on changing codes.

“All dental assistants who are registered in California have to attend continuing education courses,” she says.

Those courses are centered on back office procedures and new techniques in dentistry. But for front office staff, similar workshops are few in number.

“So I would encourage dentists to send whoever is responsible for their billing to any update seminars each year so that they can stay current, and in turn create more revenue for the practice.”

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Is the person responsible for billing at your practice current on the new dental codes? There are more than a handful of changes that took place January 1, 2018. And if your practice is still using old codes, that's likely costing you money in the form of lost revenue. But it doesn't have to be that way. Update courses can help your staff stay current and keep your practice profitable.

 Dentistry is about being a good mechanic, figuring it out, and explaining to the patients what’s best for them.

	He was a nationally ranked tennis player while growing up in South Florida, and rallied with the likes of Andy Roddick before his climb to national fame.

But even then, Jeremy Kay, DMD, recognized that he did not have the skill set to compete at that level.

“I really enjoyed it,” says Kay, who today, at age 32, is the leader of 

 in Philadelphia. “It was more than a hobby. I loved to play, and I still love to play.”

Instead, he’s serving up aces in dentistry as he has already become well known for his complete smile makeovers.

Despite his love for tennis, Kay says he always had a passion for dentistry, in no small part thanks to his father who is a prosthodontist. The senior Kay brought his son to his office while in grade school, enabling him to visualize the impact he could one day have on people’s lives.

“It was a huge influence on me,” Kay says. “As I got older I explored other things, like finance and medicine, but none of them made the day go by fast. Whenever I was in a dental office I knew that was where I wanted to be.”

But how does someone so relatively young take of the reins of highly successful dental practice? Kay says the stars were all aligned, adding that, “It’s better to be lucky than good.”

Which is not to say Kay isn’t good at his craft. But connecting with one of his teachers from The University of Pennsylvania School of Dental Medicine at a time when Kay and his wife were “romanticizing” about moving back to Philadelphia demonstrated how timing can mean everything. His teacher was nearing the end of a long and wonderful career, so he hooked Kay up with his partner of nearly 30 years and everything clicked.

“As soon as we met we knew that it would be a perfect marriage,” Kay says. “We all enjoy each other, and we all learn from each other. And it all stemmed from my relationship with my teacher and his respect for me as a student.”

As Kay approaches his one-year anniversary since taking over as head of The Dental Spa, he has already had phrases linked with him and the practice. Phrases like “smile architect” and how he considers each patient’s “dental properties.”  Kay says those philosophies come from the many mentors he’s been fortunate to associate with.

“I was fortunate to be mentored by some very intellectual people who really taught me that dentistry is more philosophical than technical,” he explains. “And I probably say that at least once a day.”

Kay says he takes a big picture approach to dentistry. He tries to visualize each patient’s situation, asking himself, “What’s going to happen next?” in order to prevent that next thing from occurring. That approach of looking at the emergent things that might occur, Kay says, saves patients time and money. In some respects, he equates it to having foresight and, in some respects, being a good auto mechanic.

“If you’ve ever had to change the tires on a car, you know if you only change one tire the car is never going to run right,” Kay explains. “[Dentistry] is about being a good mechanic, figuring it out, and explaining to the patients what’s best for them.”

When Kay completed dental school, he and a colleague wanted to explore different cultures and help serve an impoverished community. An opportunity arose through the University Of Pennsylvania to go to Da Nang, Vietnam. They jumped at the opportunity and spent a month waking at six every morning to do sealants and provide dental care for many of the underserved communities in that part of the world.

“It was truly enriching, and they were very appreciative,” Kay recalls.

But it was also educational, Kay says, providing people of the region an education that he hopes will serve them the rest of their lives. It also made Kay some of the things westerners often take for granted.

“It gave us an even greater sense of empathy,” he says. “We had to develop our own ways of communicating with some of these people because we couldn’t speak the language. So we were learning alongside them, and it was very enriching.”

Kay also carries with him life lessons from his time on the tennis court. One of those lessons is about commitment. He rose every morning at seven and “worked my tail off” to try and become better.

“I didn’t have the skill of an Andy Roddick or some of those guys who were natural-born athletes, so I outworked a lot of my opponents,” Kay says. “I think that contributed to some of my success, and helped from a life lessons standpoint.”

Kay continues to educate and help others. His practice was recently featured twice on a new TLC show, “Say Yes: Wedding SOS,” where he was asked to help some couples who needed dental work ranging from minor touch-ups to heavy reconstruction. The goal was to help them feel comfortable when they smile at their wedding, something Kay was very familiar with.

“I just got married to my long-time sweetheart two years ago, so I know how often they made us smile and look at each other,” he says. “I know the experience those photographers and the people involved with the wedding put you under. So you want to be confident, and you want to display your best sense of self. I felt very privileged to do the show.”

By his own admission, becoming an exceptional aesthetic dentist and helping people is part of what fuels Kay’s passion and spirit.

“It’s not always about the task at hand,” he says. “It’s the process of growing, and creating a new experience for my patients.”

Jeremy Kay, DMD, is an expert in cosmetic and implant dentistry, and he specializes in complex cases requiring a level of care and expertise beyond the limitations of general dentistry. But that career might never have happened if Kay hadn't recognized he was not going to rise in the national tennis rankings alongside Andy Roddick.



Gruebele believes that dental practice owners look at their income, but often ignore their expenses.

“Dentistry is a craft,” says Keith Gruebele. “It’s an art, a skill and a passion.”

However, that’s only half the equation says Gruebele, senior vice president at 

. The other half is managing the business of dentistry. And unfortunately, he adds, too few dentists are doing that.

“If you’re not managing the business of dentistry, you might be managing yourself out of business,” Gruebele says. “Too many dentists are not looking at numbers more carefully.”

Those numbers that relate to a practice’s profit margins can make or break the equation.

Gruebele explains that profit margins change based on demographics and the market in which a practice is located because that will often impact the fees a practice can charge. However, two important ratios he believes dentists need to examine are new patient flow and collection rates.

“It’s critical to constantly add new patients,” he says. “If you’re not adding, you’re not growing. And if you’re not growing, you’re shrinking.”

So, what marketing strategies have you recently invested in? Are you effectively using social media? Are you getting and leveraging patient reviews? Marketing, Gruebele says, is an investment that can deliver big rewards. And part of that investment involves leveraging technology. He recommends improving patient contact rates by using a customer relationship management system, or CRM, to send custom emails or texts to patients.

“Not only can this save your staff from a tedious task, it can add value to patients,” Gruebele says. “And hopefully get them through the door more often.”

But just getting them in the door is not enough. If your collection rates are down, it means you’ve invested your time and that of your practice staff, invested materials, but you’re not getting paid for work you’ve done. A proper target, Gruebele says, is to aim for 96 to 98 percent collection rate based on office service performed.

“Even a two percent uptick in collections is a huge income boost,” he explains.

Gruebele believes that dental practice owners look at their income, but often ignore their expenses. He recommends a simple, practical idea that’s hiding right inside the practice’s supply closet. By initiating a quarterly cleanup day, you can manage and evaluate the inventory of your supplies.

And this first quarter of the year is a perfect time to begin that assessment, as well as to negotiate.

“What was the total spent last year, and what was the biggest chunk of that?” Gruebele asks, rhetorically. “Then, start shopping around the biggest chunk of that invoice. Chances are your suppliers will start realizing, ‘Wow, they’re going to shop everything around.’ And from a sales perspective, they’re not going to want to lose the account over a couple of percentage points or a couple of dollars per item.”

Next, consider what amenities you can cut across the board. For example, are patients really reading the magazines in your waiting room? Or are they glued to their smartphones or laptops? Wi-Fi, Gruebele says, is one of the most critical amenities for a dental office environment.

“It makes people feel comfortable coming into the office,” he says. “It shows that you’re with the times, and engaging them on their device of choice.”

Similarly, Gruebele doesn’t believe having cable television available in the waiting room is doing the practice any justice. Instead, if you have a TV in the room, for a modest price, he recommends putting up patient testimonials related to the experience they had during their visit.

“That’s going to go a lot further than Days of Our Lives,” he says. “The reality is, whatever people want is on their phone. So, give them something that they’re not expecting.”

Gruebele recognizes that for some dentists the fear of social media is real. They may not understand it or have a level of comfort with it, but he stresses that it’s important to evolve. That’s where dentists need to leverage their staff.

“Specialize them in a task or chore that empowers them, that is measure, where they can see their impact that makes them feel like they’re contributing to the office,” he says. “Make their success your success.”

And you don’t need a huge social media campaign to get the ball rolling. Take the first step. Have someone take photos of the staff; post comments about what you’re doing in the community; or talking about even silly national holidays like national hamburger day.

“It’s quirky and funny, and it gives people a relief,” Gruebele says. “But it’s also a constant reminder that their dentist is involved in the community, and is sharing information with them.”

Are you setting goals for collection rates and celebrating when they're reached? What about conducting annual competitive market analyses to compare the costs of services and ensure your practice is competitively priced? Reviewing income, leveraging technology and managing expenses will go a long way toward helping dental practices improve their profit margins.

Small Changes Can Improve Practice Profit Margins

 Dental offices rank as the number one profession for the poorest air quality.

In the summer of 1974, the Hollies had a Top 10 hit when they sang, “All I need is the air that I breathe and to love you.”

They were smart enough to recognize the importance, even in a midst of a heated romantic relationship, of breathing clean, fresh air.

According to Department of Labor statistics published in 

, the dental profession ranked number one for the poorest air quality. In addition, the Environmental Protection Agency 

 that indoor air quality can be five times more toxic than outdoor air.

“It is accurate, and it’s also low,” says Steve Levine, Chief Executive Officer, of Fairfield, Connecticut-based 

. “I think [indoor air quality] is actually worse than that.”

And failure to recognize that is problematic for dental practices.

Levine explains that the toxicity of indoor air is a result, at least in part, of everything brought inside by people — emissions, fumes, dust particles, mold spores and the like. Every building must bring in at least 20 percent outside air. When that happens, you increase the amount of contaminants already present in indoor air thanks to carpeting, machinery, chemicals and people — all of which are present in a dental office.

These are often ultrafine particles, Levine says, and if someone in an office gets sick and sneezes, those particles transfer from person to person and make others sick. In dental offices, the opportunity for transference of these particles is even greater.

“In dental offices, the issue of bacteria, viruses and germs is critical,” Levine says. “People are opening their mouth, and because their mouth is open, they’re spreading particles to other people. All those particles are floating in the air and on surfaces.”

To help illustrate, Levine points to the times sunlight shines into a room through a window and thousands of tiny particles can be seen floating in the air. That, he says, is what everyone is breathing. And when patients and office staff move from room to room, those particles go with them.

Allen Walker, DDS, is creating the cleanest air possible for his patients and staff at 

 in Texas. And he’s able to do that because he was listening.

Walker already knew he had a wide mix of patients, including many older patients who suffer from respiratory issues. One day he heard two of them talking in his waiting room about how they don’t like going to the doctor because they’re afraid to going to catch something sitting in a waiting room filled with sick people.

“I thought, if there are people who are afraid of coming here, I need to do something to assuage their fears,” Walker recalls thinking.

He researched how hospitals were addressing the problem of poor air quality, but remodeling his entire office with a large air filtration system was cost prohibitive. And then a friend told him about 

, a continuous UV-C air purification system that damages the DNA in contaminants, effectively rendering them inert.

Walker installed six in his practice at a total cost of approximately $6,000.

“I live in a small town,” he explains. “I may do a root canal or filling on someone, and that night or that weekend I may be at the little league softball field and I’m talking to them. So because it’s a smaller community it means you care about the person when they’re here, but you’re also concerned about them when they leave. And in a small town if someone gets infected in your office it will take about three seconds for everyone in town to know it. That would be the worst publicity you can imagine.”

If you’re considering integrating some type of air filtration or purification system into your practice, Levine recommends applying a good rule of thumb. Major architectural firms like Gensler indicate that productivity benefits per employee should range between $1,600 and $2,300.

“Typically in a dental office, if we put in one system that covers 2,000 square feet, you’re talking about a cost of $1,600,” Levine says. “So, if it benefits one employee, it pays for itself.”

And the external public relations isn’t bad either.

“[An air filtration system] doesn’t bring in an extra dollar,” Walker says. “But it does send a message that the dentist is willing to spend money he doesn’t have to in order to make the office a little safer for patients.”

The Environmental Protection Agency says indoor air is five times more toxic than outdoor air. Some people think it's even worse than that, and dental practices are among the worst contributors. But investing in an air filtration or purification system can go a long way toward keeping patients and staff healthy, and improving productivity.


Dental Practice Air Quality: What You Can't See Can Harm You

The IRS allows you to deduct all of your equipment on some basis, so if you don’t do a 179 it doesn’t mean you don’t get to deduct it.

December 31, 2017, has come and gone, so it’s time to put any thoughts about taking advantage of the Section 179 deduction in the rearview mirror, right?

 of the IRS tax code allows businesses to deduct the full purchase price of qualifying equipment and software purchased or financed during the tax year. To take this deduction for tax year 2017, the equipment must have been purchased 

But does that mean dentists should simply forget about 2018? Or beyond?

“What I don’t like is when some dental reps use [the 179 deduction] as an end-of-the-year sales tool,” says Dawn Renner, CPA, MBA, a member of the 

National Society of Certified Healthcare Business Consultants

 and owner of the Minnetonka, Minnesota-based Management Accounting Group, Ltd. “And sometimes the 179 has some negative, unintended consequences.”

Renner explains that dental reps are not the only guilty party when it comes to “pushing” the 179 deduction. Some accountants who want to save their dental clients lots of money one year also contribute to the problem.

“You can look like a hero that one year, but when the dentist has to pay the principal on that purchase in year two and three and four and doesn’t have any deduction to offset it, that’s not a good thing,” Renner says.

That creates a “double whammy” on cash flow, Renner continues. Dentists could find themselves paying out principal but also paying tax on that principal. The other consideration is whether or not your state allows a 179 deduction.

“I’m in Minnesota,” Renner says, “and the state does not allow the same deduction as the Federal.”

Perhaps most importantly, Renner suggests dentists step back and ask themselves if they would make the purchase regardless of the time of year. The website Section179.org explains that most tangible goods, including off-the-shelf software and business-use vehicles qualify for the 179 deduction. But do you need to make that purchase?

“Even if you don’t get the 179, you buy the equipment, you get to deduct 100 percent of it,” Renner says. “It’s just a timing thing.”

It’s important to remember the qualifier that whatever the purchase, it must be put into service during that tax year. So just because you purchase a new piece of equipment or invest in new practice management software in December, you won’t be able to deduct the full price if you don’t implement its usage before the end of the month. And with some new equipment and/or software, training is involved. That could run well into the start of the New Year.

“It’s one of those things that we have some control over to make it fit the situation that’s best for each of our clients,” Renner says. “So if you rush to buy something in December and can’t put it to use, you won’t be able to deduct it anyway.”

And then there’s the question of whether it makes more sense to take the deduction in one lump sum or to depreciate over time. Renner suggests that for a new start-up practice, or one that might be in its first year or two of existence, there might be more “bang for the buck” by depreciating the purchase over a longer period of time.

“In the first couple of years the practice won’t be at its highest earnings potential,” she says. “You’re still building the practice. And with the depreciation, you can never deduct more of a loss than you have basis or skin in the game. So if you don’t have a lot of equity, you can’t take all of your depreciation.”

The other consideration where the Section 179 deduction is concerned is the possibility of bonus depreciation. There are some years it’s offered, and some it isn’t. For 2017 the bonus depreciation is offered at 50 percent. It’s useful because it accelerates the deduction by front-loading the depreciation in the first few years. However, it only covers new equipment.

Does your practice qualify? For 2017, the Section179.org indicates that “All businesses that purchase finance, and/or lease less than $2 million in new or used business equipment during tax year 2017 should qualify” for the deduction. To be certain, Renner says it’s worth a 10- or 15-minute conversation with your tax professional to make sure you use the deduction in the most efficient manner possible.

“The IRS allows you to deduct all of your equipment on some basis, so if you don’t do a 179 it doesn’t mean you don’t get to deduct it,” Renner says. “It needs to work for you.”

The Section 179 tax deduction allows dentists to save big on major equipment and software purchases, but is it right for your practice? And while the deduction has been promoted as an end-of-the-year tax strategy, it should more accurately be positioned as part of your practice's overall objective.



Make the Section 179 Deduction Work For Your Practice

When Manuel Cordero, DDS, CPH, MAGD, informed his father that he had graduated from dental school, the reaction was unanticipated.

In retrospect, Cordero really wasn’t surprised by the response. Cordero attended Haverford College in Pennsylvania, and explains that “… most of the graduates end up going to medical school or law school.”

But during his sophomore year, Cordero developed a severe toothache. Since he was at Haverford on scholarship, the college sent him to a dentist in nearby Bryn Mawr. In less than one hour, he recalls, the dentist examined, diagnosed, treated and resolved his problem. Cordero was blown away.

“I saw an office that was my image of what a physician’s office should be,” he says. “I was raised by two brothers-in-law who were both surgeons. However, my perspective as to what I wanted to do in life changed in that moment.”

Today, Cordero walks into his practice in Sewell, New Jersey, each day and says, “Thank you, God, for putting me on the right path. Because this is what it’s all about. The entry point to health is the oral cavity.”

Cordero, who has been in practice for 34 years, has actively been involved with the Academy of General Dentistry (AGD) for more than 20 years, and last November was installed as the 

 He says that being part of AGD changed him from a good dentist into an exceptional one.

“In the beginning (of a career the AGD) is going to empower you with knowledge you don’t have,” Cordero explains. “If you’re in the middle of your career, it’s going to continue to expand your horizons and make you more successful. If it is at the end of your career, it’s going to make sure that you prepare for a good retirement in a way that you still enjoy your profession and you can see a financial reward at the end. So, every single stage of your life is improved.”

That’s why Cordero has opted to “pay it forward,” becoming actively involved in the organization to make certain it continues doing for others what it did for him. And when the AGD went global about five years ago, those benefits reached an even larger audience.

“Our goal is to continue training people in other countries so that they can also improve the quality of oral health in their communities, and, as a result, overall health,” Cordero says.

Cordero knows that as president of the AGD he can’t change the world in one year. But he does want to change the perspective that the world has of the AGD. More specifically, he wants members to understand the AGD is there to serve them; to make sure they’re successful, and thereby impact the health of the general public.

“The goal is to make things better for everyone else,” he says.

There are also challenges: increased competition in the form of corporate dentistry; raised standards but lowered remuneration from insurance companies; and increased government regulations. Cordero wants to make certain AGD members have the tools and abilities to face these challenges, while at the same time increase the quality of care they provide.

“Our focus is not going to change,” he says. “It doesn’t matter what’s going on in the politics of the world or the economy; we are focusing on one thing and one thing only: empowering through education. We want to empower through education. We are the graduate school for all the dental schools in the world.”

On the education front, Cordero says that students attending dental school graduate with greater debt than any other profession — and that includes medical, legal and engineering. As such, the AGD is focused on helping with student loan repayment and student loan forgiveness.

“There are many programs that allow them to work in underserved areas and get credit toward their debt,” Cordero says. “We want to make sure that we’re there from the very beginning for those students so that we can help them with their own educational pursuits while they’re in school, and then when they graduate.”

Cordero says that, in addition to his experience as a sophomore in college, one of the factors that turned him from a career in surgery to dentistry was the issue of balance. He saw his brothers-in-law either always at the hospital, or being on call and disappearing suddenly. That’s not what he wanted for his family.

“I wanted to raise my own children,” he says. “I wanted to raise my own family. Because the most precious thing in my life is my family.”

Walking the walk, Cordero started his career in a home-based practice. Eventually, he expanded and opened a second office because he was “becoming a little claustrophobic” with no place to go. That helped him achieve a proper balance.

“The one office was super busy and crazy, and it was in my house; the other one, remotely, was just as busy, but I was doing it just to serve,” he says. “There was no financial reason for me to be there, but it gave me so much back, because it gave me back my cultural connection that I had lost. And so my balance between my family life and my professional life was fulfilled that way.”

The recently installed president of the Academy of General Dentistry initially discouraged his children from a career in dentistry. He told them dentistry is a difficult field, and the only reason you do it is if you love it, and feel you're going to make a difference in the community where you serve. The result? Three of the four have followed in his footsteps.