North Texas Dentistry Volume 2 Issue 3

VOLUME 2 | ISSUE 2

Practice ManagementSatellite Economics

Money MattersSaving Money on Healthcare

Practice TrendsA Case for Professional Management

DentalAnesthesiaSpecialistsDr. Shawn SeifikarDentist Anesthesiologist

North Texas

Dentistrya business and lifestyle magazine for north texas dentists

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www.northtexasdentistry.com | NORTH TEXAS DENTISTRY 3

ON THE COVER

Dentist Anesthesiologiston the GoDr. Shawn Seifikar, Dental Anesthesia Specialists

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North Texas

Dentistry

BAYLOR COLLEGE OF DENTISTRYTwo Faculty Members, Two National Organizations and a First for TMHSC-BCD

PRACTICE MARKETINGHow to Maximize Your Pay-Per-Click Advertising ROI

SPECIAL ISSUE Q&ACreating the Ultimate Dental PracticeA guide for dentists

LAWYER’S CORNERHow to Avoid Being Suckered in a Protracted Buy-Out Scenario

COMMUNITY NEWSBuild a Bridge, Save a LifeHelping breast cancer patients

COMMUNITY EVENTS2012 SBANT BowlathonHave fun and raise money for the Spina Bifida Association of North Texas

THE TEXAS MEETINGTexas Dental Association Annual Session

MONEY MATTERSSaving Money on HealthcareStretching your healthcare dollars

PRACTICE TRENDSThe Case for Professional ManagementReducing practice overhead

PRACTICE MANAGEMENTSatellite EconomicsAccelerate your plans for retirement

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6 COVER FEATURE: Dr. Shawn Seifikar has an ambulatoryanesthesia practice serving the DFW areaand provides anesthesia services for pedi-atric patients, special needs patients andphobic adult patients in both an office andhospital setting.

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28COVER Photos: Ray Bryant, Bryant StudiosLower right photo courtesy of Dr. Shawn Seifikar

NORTH TEXAS DENTISTRY | www.northtexasdentistry.com4

Welcome back to North TexasDentistry! Spring is on the way, flowersare beginning to bloom and it is a beautifultime of year.

For this issue North Texas Dentistryhit the road as we traveled with Dr. ShawnSeifikar. Dr. Seifikar is “on the go” as heprovides anesthesia for patients needingsedation for various dental procedures. Heprovides sedation services for specialneeds patients at the Ford Clinic, pediatrichospital cases at Our Children’s House atBaylor and in private dental offices forpatients of all ages. We observed andappreciated his caring manner and profes-sional technique with the patients.

In the light of current economics, non-profit organizations are working diligentlyto raise funds for their programs. NorthTexas Dentistry is pleased to give a littlepress to help promote these causes. Theprograms featured in this issue are variedand serve different populations, so pleasecheck out the information for the BridgeProgram, the Spina Bifida Association ofNorth Texas Bowlathon and the Bryan’sHouse Open. We encourage you to partic-ipate and make a difference!

The practice of dentistry is forever chang-ing. Check out different points of view on practice opportunities in The Case for Professional Management by KirkHuntsman and Satellite Economics by Dr. Richard Lyschik. If you are an associateor considering having an associate you will

be interested in the article, Long-TermTransitions: How to Avoid Being Suckeredin a Protracted Buy-out Scenario by attor-ney Joseph McGregor. It is important for all parties involved to have a contract. In another article, Saving Money onHealthcare by Bob Michaels, pick up sometips on reducing healthcare costs.

The Ultimate Dental Practice SpecialIssue is on the horizon. Check out the Q&Ain this issue to find out the details. Thencontact North Texas Dentistry to be part ofthis issue!

Update on Smiles in the Spotlight… I havehad questions about the cost of presentinga case in this feature. The purpose of thisfeature is to share procedures with yourcolleagues and there is no charge. If youhave high quality photographs and inter-esting cases, sign up today to share yourSmiles in the Spotlight presentation.

Thanks to all of you who support NorthTexas Dentistry and make its publica-tion possible!

Keep smiling and have a great day!

Lulu Stavinoha, RDHPublisher

from the publisher

Publisher | LuLu StavinohaPhotographer | Ray Bryant, Bryant StudiosContributing Writers | Tina Cauller, Marc Fowler,Jennifer Fuentes, Kirk Huntsman, Dr. Richard Lyschik,Joseph L. MacGregor, Bob Michaels, Terri Wilson-Gray

Although every effort is made to ensure the accuracy of editorial material published in North TexasDentistry, articles may contain statements, opinions,and other information subject to interpretation. Accordingly, the publisher, editors and authors and theirrespective employees are not responsible or liable forinaccurate or misleading data, opinion or other informa-tion in material supplied by contributing authors. Copyright 2012. All rights reserved. Reproduction inpart or in whole without written permission is prohibited.

Advertise in North Texas DentistryFor more information on advertising in North Texas Dentistry, call LuLu Stavinoha at (214) 629-7110 oremail [email protected]. Send written correspondence to: North Texas Dentistry P.O. Box 12623 Dallas, TX 75225

North Texas

Dentistry


It was a late March afternoon when Dr. Gerald Glickman gave his incomingaddress as president of the American DentalEducation Association in a ballroom at theHilton Orlando Bonnet Creek.

Just days later and less than 100 miles away,Dr. Rena D’Souza was installed as presidentof the American Association for DentalResearch during the organization’s 2012annual session at the Tampa ConventionCenter.

The occasion is one for the dental school’shistory books. For the first time, two cur-rent, full-time Texas A&M Health ScienceCenter Baylor College of Dentistry facultymembers simultaneously hold the presiden-cies of both AADR and ADEA. In fact, asD’Souza points out, it’s the first time theleaders of both highly influential dentalorganizations are separated by — literally —one floor, which gives her hope that AADRand ADEA can collaborate on mutual goals.

So what happens now?

Chairs D’Souza and Glickman, of Bio-medical Sciences and the Department ofEndodontics, respectively, have served theirorganizations for the past two years, mostrecently as president-elect, so when itcomes to their goals for AADR and ADEA,each of them has a sharper focus than everbefore.

Dr. Rena D’Souza

AADR served as D’Souza’s ‘window to theworld’ during her years as a developing fac-ulty member. That fact may explain her zealfor strengthening its membership, reaching

out to dental schools that lack researchinfrastructure and developing opportunitiesfor junior researchers to network with sea-soned professionals.

(CONTINUED ON PAGE 22)

By Jennifer E. Fuentes

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www.dentalcerts.com

For info, email: [email protected]

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Courses presented by Kayce Hollingsworth, CDA, RDACo-sponsored by Texas A&M Health Science Center, Baylor College of Dentistry, Office of Continuing Education, ADA-CERP Continuing Education Provider, and approved by the Texas State Board of Dental Examiners

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CE Credits - Either course may be taken by Dental Assistants & Hygienists for 6 hours CE credit. Review course only, no exam. Course fee - $149

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RDA Registration Course (1-day class)May 25, Jul 27, Sept 29, Oct 27 8am - 5pm Covers Infection control, Radiology & JurisprudenceState Board Exam given at the end of class.Includes downloadable manual. Course fee - $199

Nitrous Oxide Monitoring (1-day class)June 22, Aug 25 8am - 5pm Prepares Dental Assistants & Hygienists toobtain certification in Nitrous Oxide Monitoring.State Board Exam given at the end of class.Includes downloadable manual. Course fee - $199

OSHA Annual Updates Lecture & Infection Control Apr 21 8am - noon CEUs - 4 hour lecture - 1st hour is OSHA update requirements followed by 3 hours of Infection Control and State Board requirements. Includes course download, OSHA certificate and CE letter. Course fee - $149

FACULTY MEMBERSNATIONALORGANIZATIONS

22and a first for

TAMHSC-BCD


Anesthesia in dentistry

The profession of dentistry introduced safe and reproducibleanesthesia to the world in December of 1844, a year before thestate of Texas was established. In 1848, the American MedicalAssociation gave the first of several recognitions that dentistryintroduced anesthesia to the world, more than 30 years before theAmerican Society of Anesthesiology was established. Dr. LeonardM. Monheim established the first autonomous Department ofAnesthesiology within the University of Pittsburgh School ofDental Medicine in 1949 and initiated the first postdoctoral train-ing program in anesthesia for dentists.

Dentist anesthesiologists have been providing various types ofanesthesia for decades now and have many modalities availableto them for patient management including oral sedation with localanesthesia and nitrous oxide, intravenous conscious sedation,

total intravenous anesthesia and inhalational general anesthesia.Their special training and expertise has made access to care a real-ity for a variety of patient populations that otherwise could not beattended to.

After obtaining his DDS degree from Baylor College of Dentistry in2006, Dr. Shawn Seifikar completed a three-year post-doctoral den-tal anesthesiology residency program, a unit of the medical anes-thesiology residency program administered through the Universityof Pittsburgh Medical Center (UPMC) medical education program.His education and training experiences were directed and coordi-nated by the faculty of the department of Dental Anesthesiologywithin the School of Dental Medicine and the department ofAnesthesiology within the School of Medicine. His anesthesiologytraining consisted of medical rotations in internal medicine, crit-ical care, chronic pain and anesthesiology at UPMC Presbyterian

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Dentist Anesthesiologiston the GoDr. Shawn Seifikarby Tina Cauller

Dr. Seifikar provides dental anesthesia services in conjunction with a variety of dentists and dental specialists, including pediatric dentists, endodontics, periodontics, oral surgeons, and dentists with special needs patients.


Hospital, Montefiore Hospital, Magee Women’s Hospital, SaintMargaret’s Hospital, Children’s Hospital of Pittsburgh and theCenter for Special Needs Patients at the University of Pittsburgh’sSchool of Dental Medicine.

Today, Dr. Seifikar has an ambulatory anesthesia practice servingthe DFW area and provides anesthesia services for pediatricpatients, special needs patients and phobic adults in both an officeand hospital settings. Dr. Seifikar provides anesthesia and seda-tion services at the dental office, minimizing patients’ fears andensuring that anxious children and adults will cooperate to allowthe dentist to complete their dental care. Beyond the simple oralsedation or nitrous oxide typically provided in “sleep dentistry”clinic settings, deep sedation or general anesthesia is provided bylicensed dentist anesthesiologists. These forms of anesthesiaallow the patient not just to relax, but to actually sleep during theprocedure, resulting in a safer, more comfortable and productiveappointment. The safety record of advanced anesthesia servicesby dentist anesthesiologists is unsurpassed in today’s healthcareindustry. Recent anesthesiology literature estimated the risk ofanesthesia performed by a dentist anesthesiologist for dental pro-cedures ranges from 1 in 2,000,000 to 1 in 4,000,000.

Dr. Seifikar is committed to ensuring that safety is the single high-est priority during every procedure. All patients are vigilantlymonitored with state of the art equipment including NIBP (Non-Invasive Blood Pressure), Pulse Oximeter, EKG, and PrecordialStethoscope. Emergency equipment equivalent to that carried bythe EMS (Emergency Medical System) is brought to everyappointment. Dr. Seifikar provides individualized support to hispartner dentists, offering thorough instruction on optimizingsafety so they are prepared and confident should an emergencyarise. He is involved in lecturing and provides continuing educa-tion on topics of general anesthesia, lV sedation, enteral sedationand office based medical emergencies. He holds certifications asan instructor in Basic Life Support (BLS), Advanced Cardiac LifeSupport (ACLS) and Pediatric Advanced Life Support (PALS).

The pediatric population

The fear of a protracted dental treatment and multiple local anes-thetic injections can turn an otherwise cooperative child into afrightened and inconsolable patient. Early negative experiencescan lead children to have anxiety about seeing the dentist andmany children will carry these fears into their adult lives, compro-mising their comfort with even routine preventive care. Anesthesiacan be a helpful adjunct to treatment for fearful children.

Dr. Seifikar is a staff dentist anesthesiologist at Our Children’sHouse at Baylor and has been working closely with the BaylorCollege of Dentistry’s Pediatric Dental Department. Having hos-pital privileges enables him to provide his anesthesia services ina JCAHO-accredited surgical center. He also provides anesthesiaservices in the pediatric dental office setting, and finds that thefamiliar surroundings support optimal comfort and confidence

for young patients and their parents. His specialized training inboth the office and hospital setting allows the pediatric dentalteam to perform procedures with the patient under anesthesiawith a breathing tube or laryngeal mask airway (LMA) or sedatedwith an open airway.

TYLER’S STORY

When Tyler, an adorable three-year old, fell and bumped hisfront teeth, they fractured because of extensive caries on thelingual surface that had gone undetected. His dentist’sefforts to treat him with oral sedation and nitrous oxidewere unsuccessful. After presenting parents with anestheticoptions his dentist called on Dr. Seifikar, who came to theoffice to ensure that Tyler cooperated and was comfortablethroughout the procedure. With the help of a topical numb-ing spray, an IM injection was given, allowing Tyler toachieve a dissociative state while he was still in his mother’sarms. Tyler was then gently taken to the dental operatoryand connected to all monitoring equipment. Venous accesswas obtained and infusion of intravenous medicationsallowed Tyler to become sedated and sleep throughout theprocedure. At the completion of procedure, IV infusions ofmedications were stopped and Tyler emerged from thesedative state. He was then returned to his mother justbefore becoming fully awake and alert, completely unawarethat a separation from her had taken place. Tyler’s brightsmile was restored without a single tear or any distress.

Dr. Seifikar performs a thorough evaluation and physical exam on every pediatric patient. He explains the anesthesia plan to the parents and answers any questions prior to start of the procedure.

“I have enjoyed working with Dr. Shawn Seifikar. I am impressed by his compassionate care of my pediatric patients. He is dedicated to the practice of anesthesia with a strong emphasis on safety.”

– Dr. Mila Davis, Frisco Pediatric Dentist


Fearful adults and adolescents

For particularly fearful or claustrophobic patients or those withhyperactive gag reflex symptoms or difficulty getting numb, intra-venous sedation can a helpful solution. As Dr. Seifikar explains,“Intravenous sedation offers fearful patients a way to get the den-tal care they need and have a relaxed, pleasant experience. Oneof the wonderful features of IV sedation is its ability to be cus-tomized to the specific desires of both the patient and the treatingdentist. Patients can be awake and relaxed or sedated and dream-ing of their favorite vacation.”

All types of dental care, including restorative, fixed, exodontia,endodontic therapy, implants and cosmetic dentistry can be per-formed with office based IV sedation.

Besides the extra comfort it provides, office based dental anesthe-sia affords appealing convenience for patients with time con-straints who need extensive treatment. With IV sedation, multiplevisits can often be condensed into a single appointment, sopatients don’t have to miss work, school, or other important activ-ities to come to several appointments and can be treated right intheir own dentist’s office. The dental team has an expanded win-dow of time to complete multiple procedures safely, and theadded efficiency enhances productivity.

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For particularly fearful patients or those with hyperactive gag reflex or difficulty getting numb, intravenous sedation can be a helpful solution.

Dr. Seifikar monitors all patients with state-of-the-art monitoring equipment, utilizing NIBP, pulse oximeter, EKG, end tidal CO2 and precordial stethoscope.

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LAURA’S STORY

Laura, a business professional in her mid-50s, had painful,traumatizing dental experiences as a young child that left herwith devastating emotional scars. Her reluctance to visit thedentist caused her to avoid routine dental treatment. She typically waited until she was in severe dental pain to seekhelp and as a result required endodontic treatment. Recently,she was referred to an endodontist who consulted with Dr. Seifikar to complete her dental team. As her husbandexplains, “Laura requires anxiety-relieving medications priorto any dental appointment and due to her anxiety and phobia,she typically does not sleep the night before her dentalappointments.” In her pre-operative consultation with Dr. Seifikar, he observed that she was extremely anxious.After explanation of the anesthesia plan and some reassuringdiscussion, Dr. Seifikar accompanied Laura to the dentaloperatory where all monitors were connected and IV accessobtained. Anxiolytic and sedative medications were admin-istered and titrated carefully, allowing Laura to sleep com-fortably for over three hours while her endodontist completedroot canal therapy on two molars. Laura was relieved that herprocedure was completed without having any recall. She wasrecovered and monitored for twenty minutes and then dis-missed. Her positive experience has given her the confidenceto seek routine dental care in the future.

Patients with special needs

For patients with autism, speech delay, Alzheimer’s or dementia,ADD/ADHD, Down syndrome, cerebral palsy, or other physicalor mental disabilities, finding access to dental care can sometimesbe a daunting challenge. These patients sometimes have compli-cated health histories or special behavioral needs and, as a result,caring for them requires special considerations beyond an ordi-nary approach to dentistry. It also demands exceptional compas-sion, patience and understanding. Because many dentists do notfeel confident in their ability to effectively or efficiently providecare to the special needs population, these patients are oftenturned away, even for routine hygiene. For this population, dentalanesthesia is often the only realistic avenue to receive safe, com-fortable dental care.

“Dr. Seifikar is a professional and a highly skilled anesthesiologist. He is dedicated to my patients and their needs. I work with many special needs patients who have complicated health histories and behavioral needs. Dr. Seifikar handles this group of patients and others with a high level of care. Patients and their families love his attentive and compassionate nature. I would highly recommend him for any patient care needs with sedation.”

– Dr. David Sorokolit, Fort Worth General Dentist

One of the wonderful features of IV sedation is its ability to be customizedto the specific desires of both the patient and the treating dentist.

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JOHN’S STORY

John is a healthy 61-year old man born with an intellectualdisability that affects his cognitive function and daily livingskills. His functional level makes it a challenge for him tomaintain a good regimen of daily brushing and flossing. Helives in a group home and his sister, who is his guardian,accompanies him to doctor visits to help him communicateand serve as decision-maker. Because it is difficult for Johnto hold still and keep his mouth open for a dental exam, it tookyears for him to find a regular dental care provider. As a resultof inconsistent hygiene and delayed restorative care, nearly adozen of his teeth had been extracted. By the time his familyfinally found a dentist that serves patients with special needs,dental neglect had taken a significant toll on John’s oralhealth. Dr. Seifikar, who treats special needs patients in a den-tal office setting, has been working with John’s dentist for overtwo years taking care of special needs patients similar to John.

On the day of appointment with Dr. Seifikar, John’s medicalhistory and medications were reviewed with his sister. A focused examination was completed by Dr. Seifikar in thepre-operative area and then John was wheeled to the dentaloperatory. Monitors were placed and venous access obtained.Anxiolytic medications were administered, allowing John tocooperate with x-rays and oral examination, which revealedthe need for two restorations and a deep cleaning. Shortlyafter, an induction dose of a general anesthetic drug wasadministered and a Laryngeal Mask Airway (LMA) wasplaced and connected to the breathing circuit. John was mon-itored closely and remained stable throughout the case. Atthe completion of the procedure, John slowly emerged froma state of general anesthesia and was transported to therecovery area to be with his sister. John’s first experience wasa complete success and he is comfortable coming back to see Dr. Seifikar once a year.

Synergy of teamwork

Dr. Seifikar provides his anesthesia services in conjunction with avariety of dentists and dental specialists, including pediatric den-tists, endodontists, periodontists, prosthodontists, oral surgeons,and dentists with special needs patients. Partnering with the den-tist anesthesiologist creates synergy and expands the scope andcapabilities of the practice, enhancing patient loyalty and boostingproductivity.

Since Dr. Seifikar was a practicing dentist before becoming a den-tist anesthesiologist, he is intimately familiar with the intricaciesof dental procedures and can orchestrate anesthesia that perfectlyanticipates each stage of the procedure. Recognizing which portionof the procedure is the most stimulating allows him to bump thelevel of anesthesia at precisely the right time to keep the patientoptimally comfortable.

When Dr. Seifikar brings his dental anesthesia services to a privatepractice, he comes into the office as a colleague. Dentists appreciatehis mindful and courteous approach to teamwork. “I am there torender a service and serve as part of a team,” he notes, “but I rec-ognize that I am a guest in the office. I bring what I need and I cleanup when I leave. The patient comes away with a positive experienceand practice loyalty is reinforced.”

Dr. Seifikar is a professional member of American Society ofDentist Anesthesiologists, Society of Pediatric Anesthesiologists,North Texas Dental Society and Dallas County Dental Society. n

For more information or to schedule an appointmentplease call (972) 591-3355 or visit www.daonthego.com.

Dr. Seifikar is placing a flexible LMA after induction of anesthesia. The LMAallows the patient to have an airway throughout the procedure connected toa breathing circuit.

Special needs patients sometimes have complicated health histories orspecial behavioral needs and dental anesthesia is often the only realisticavenue to receive safe, comfortable dental care.


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We hear from a lot of dentists that they’ve tried PPC (pay-per-click) advertising in the past and it didn’t work. That’s not sur-prising since most PPC is done poorly. What generally happensis a few generic, boring ads are created, the clicks/visitors aretaken to the home page of the practice’s website, a daily budgetis set, then the campaign is put on autopilot and forgotten.

This approach will always generate lackluster results, particu-larly here in North Texas. We work with dentists across the U.S.and a handful in Canada and the online advertising market inNorth Texas is one of the most competitive we have worked in.The main reasons for this are the number of dentists comingout of Baylor that want to stay in the area and more local den-tists allocating their marketing dollars to the internet. Given thiscompetitiveness, North Texas dentists have to work harder toachieve online success than their counterparts in other areas ofthe country.

Why most dental PPC campaigns fail

Most online advertisers make the mistake of sending visitors tothe home page of their website. Others who are more sophisti-

cated know to at least send them to the page of their websitethat matches the search term (for example a search for “dentalimplants” sends them to the dental implants page of the practicewebsite).

There are problems with both of these approaches. First, if thevisitor was searching for dental implants and ends up on thehome page, they may get distracted before they ever get to thepage about implants. Even if they were sent to the implantspage, there is still all the navigation to the other pages of the siteand they could again, get distracted.

Compounding the problem, most dental websites don’t have aclear call to action – they don’t lead the visitor to the desiredaction (setting an appointment). In many cases, you have tohunt to even find a phone number.

Utilizing landing pages for maximum ROI

If you are serious about maximizing your advertising dollars,you need to create custom landing pages for each service youare promoting. If you want to focus on Invisalign, implants and

How toMaximize Your Pay-Per-ClickAdvertisingROIby Marc Fowler

practice marketing


sedation, then you should have a separate landing page for eachof them.

This provides the searcher a consistent flow from the searchterm they type in, to the ad they see, to the page they land onafter clicking the ad. Additionally, having relevant landing pageswill improve your PPC campaign’s quality score, which resultsin paying less for each click.

Here are a few landing page best practices:

• Have a compelling headline. You only have a few seconds to grab their attention before they hit theback button.

• Keep the copy focused. Only talk about the one service that page is focused on

• Have a clear call to action. Make it very easyfor them to determine next steps.

• Have a compelling story.Why they should callyou vs. the next dentist in the Google results.

• No navigation on the page.Don’t give them theoption of clicking to other unrelated pages.

• Have a strong offer. Give them an incentive to choose you.

• Only use graphics that support yourdesired outcome. Forget the stock photos of smil-ing models.

• Make sure your core message and call toaction are above the fold. They shouldn’t have toscroll down the page.

Assume nothing – Test everything

Just because you believe a certain offer sounds irresistible, oryou love a headline, doesn’t mean your prospective patients will.Testing takes the guesswork out and lets your target audiencevote with their clicks and phone calls.

A/B split testing is where you test two variables against eachother. For instance, you send half of your visitors to a landingpage with headline 1 & the other half to a landing page withheadline 2. Once you have a statistically significant number ofvisitors, you determine the winner. The winning headline thenbecomes your control. You can continue to test it againstanother headline or test another variable such as the offer. Thekey is to only test two variables at a time so you know which onemade the difference.

Hold your PPC campaign accountable

In addition to testing, you should also have tracking methodsin place. Some testing is built into Google and Bing’s PPC plat-forms, for example – click-thru rate (CTR) tells you which ofyour ads produces the highest percentage of clicks.

The challenge with online dental advertising is that unlike manyindustries, your primary call to action is a phone call to youroffice. So, there is often no actionable event that takes place onthe website – like filling out a form or clicking a buy button. Thismakes tracking a bit more challenging.

This is where call tracking numbers come into play. These arephone numbers that are assigned to different landing pages soyou can tell which page(s) produce the most calls. The calls canbe recorded so you can go back and listen to how the phone wasanswered, most commonly asked questions, whether they werea good lead or simply a tire kicker, etc.

The next step is to calculate the ROI of your PPC campaign bylooking at variables such as; cost per click, cost per lead, caseacceptance rates, average value of a patient, etc. We’ll save thatfor a future article. n

Marc Fowler is President of Bullseye Media, LLC, a McKinney, TX based full-service digital marketing agency that specializes in helping dentists lever-age the internet to grow their practices. He can be reached at (214) 592-9393,[email protected] or by visiting OnlineDentalMarketing.com.

Call 1-800-232-3826 today for a free practice appraisal, a $2,500 value!

AFTCO is the oldest and largest dental practice transition consulting firm in the United States. AFTCO assists dentists with associateships, purchasing and selling of practices, and retirement plans. We are there to serve you through all stages of your career.

Masoud Attar, D.D.S. has joined the practice of

(University of Minnesota 1991)

Henry A. Sprinkle, Jr., D.D.S. - Arlington, Texas

(Baylor College of Dentistry 1971)

Toni P. Hamilton, D.D.S. has acquired the practice of

(University of TX Health Science Center - Houston 2007)

Robert L. Allen, D.D.S. - Arlington, Texas

(Baylor College of Dentistry 1970)

AFTCO is pleased to have represented all

parties in these transactions.

Helping dentists buy & sell practices for over 40 years.

WWW.AFTCO.NET





Q: What is the purpose ofthis issue?A: North Texas Dentistry wants todevelop a handbook for the dental com-munity to use as a guide to the manyfacets of the successful practice. Creatingthe Ultimate Dental Practicewill presentleading companies and individuals in thecommunity and will be a reference doc-tors refer back to.

Q: Who should be part ofthis guide?A: Businesses that sell products and pro-vide services to the dental profession willbe featured in the issue.

Q: How will the guide beformatted?A: The issue will be divided into sectionsto showcase the specific industries thatimpact dentistry. The categories are: The Building (real estate, architecture,construction and design), The Finances(banks, accounting, wealth management,insurance), The Equipment (dental sup-plies, specialty equipment), The Practice (personnel, marketing, management,sales and transitions), The Technology(computers, software, networking, audio-visual) and The Laboratory (full service,CAD/CAM, implants).

Q: What marketing optionsdo I have?A: Print advertising and Custom Profileswill spotlight Individuals, Companies orProducts. You may supply your own con-tent and photography or let the team ofNorth Texas Dentistry assist you for anadditional charge.

Q: What other editorial willbe part of the guide?A: The editorial team of North TexasDentistry will contribute a feature foreach section which will include inputfrom those individuals participating inthe issue.

Q: What is the deadline forthis Special Issue?A: The last day to reserve space in thisspecial issue is April 27, 2012. [email protected] or callLuLu Stavinoha at (214) 629-7110.

North Texas

Dentistrya business and lifestyle magazine for north texas dentists

Creating the UltimateDental PracticePutting it all together

special issue

Creating the Ultimate Dental PracticeNorth Texas Dentistry Special Issue

&AQ


The horror stories seem to be piling up.

An increasing number of dentists comingthrough my office are limping away froma lengthy associate position that was ini-tially pitched under the promise of pur-chasing all or some of the practice after afew years of service, but who eventuallybecame disenchanted or disenfranchisedduring the process.

Overwhelmingly these are young practi-tioners. Typically each started work at apractice where the owning dentist prom-ised the option to “buy in” after five years,but the existing dentist realized five yearslater that he had ten more years of

earnings to generate before retirementbecame a realistic option, so the “buy in”timetable got pushed back. Or, just as fre-quently, once year five rolled around, theassociate was shocked to learn the stickerprice, a price based on value the associatewas either significantly or solely respon-sible for creating. And so far, each casecould have been avoided with betterplanning and a better understanding ofthe dynamics of a long-term transition.

Maturing doctors often introduce a youngassociate into the practice to accommo-date increasing production, generate ad-ditional revenue, and hopefully shortentime to retirement. Frequently the doctorinstills incentive in the incoming associ-ate to perform at the highest level by ei-ther directly or indirectly suggesting thatthe incoming associate will have the op-portunity at some point in the future tobuy into the practice, or buy the existingdoctor out.

On its face, this arrangement is ideal. Itallows both dentists to learn each otherin order to better gauge “fit,” allows theincoming associate to get familiar withthe practice and its patients, and mini-mizes the risks attendant to most practicetransitions. Moreover, it is often the casethat the existing dentist is not at a point where selling is desirable, nor is theincoming associate fitted with resourcesenough to purchase or start a practice.

While this seems an ideal scenario, rarelyis this transaction planned thoroughlyenough to avoid the natural pitfalls inev-itable in this economic arrangement.

It should first be noted that there is a fun-damental question as to the nature of thiseconomic transaction. The existing dentistis introducing an associate to generateadditional revenue, and thereby enhancethe practice’s future value. The incomingassociate, however, will likely purchasethat future value, and therefore has anincentive to keep that future value lower.What then, is the associate buying: thevalue that he himself creates, or the valueof the practice representing the productionand contribution of the existing dentist?

Long-term Transitions: How to Avoid Being Suckered in a Protracted Buy-out Scenario

By Joseph L. McGregor

lawyer’s corner

The answer to this question is not nearlyas important as raising it in the firstplace. Essentially, there is not necessarilya right answer; failing to adequately ad-dress the question, however, is clearly thewrong approach.

When reviewing this issue with my clients,it is evident that simply initiating this con-versation with the existing doctor seemsto be the most significant roadblock. Mostassociates either do not know what ques-tions to ask, or are nervous that askingwhat seem like awkward questions willfracture the relationship before a singledrill starts spinning. Both doctors shouldrealize, however, that it is in everyone’sfinancial interest to thoroughly outlineexpectations.

First, a timeline must be established. Theeasiest timeline is a fixed one where apurchase may occur after x many years.It is arguably more advisable to install“triggers,” where a purchase may occurafter certain pre-established benchmarksare achieved.

With that understanding, it is almostmandatory that the doctors order a prac-tice evaluation—the more detailed the bet-ter. From there, it is advisable to enterinto a memorandum outlining how anyfuture evaluations will be updated. It ismuch easier to determine the future valueof the practice by establishing the criteriain the present.

The parties should then consider enter-ing into a pro forma purchase agreementencapsulating these understandings. It’simportant that both parties have theoption to walk away at any time, but thearrangement must also allow the existingdentist to withdraw from the relationshipwithout the associate wasting the yearsput into building the practice, and notallow the associate to withdraw and vacuum clients away and force the exist-ing dentist into restarting the process.Conversely, there should be mutually ben-eficial provisions that provide for death,disability, and accelerated retirement.

Once an agreeable pro forma purchaseplan is negotiated, the next step is to enterinto an associate contract that contem-

plates the arrangement in place. Associateemployment agreements should protectthe “at will” status of the associate, butalso feature compensation and perform-ance standards that reinforce the plannedtransition. This should be balanced with ahealthy covenant not to compete.

The long-range transition can be an idealpractice exit strategy so long both theexisting doctor and incoming associatehave frank, open, and honest creative dis-cussions to ensure fairness. n

Joseph L. McGregor is an attorney based outof Dallas, Texas who focuses on dental busi-ness transactions, particularly practice acqui-sitions. Mr. McGregor is a graduate of BrighamYoung University Law School.


IMPACT LIVES THROUGH THE ART OF DENTISTRY AND START OUT DEBT-FREE


T he concept of The Bridge Breast Network was born in1992 and was nurtured by a group of breast cancer sur-vivors who met in the office of Dr. Sally Knox, M.D., a

breast specialist at Baylor University Medical Center in Dallas,Texas. Dr. Knox often donated her services to her patients wholacked the resources and insurance coverage for breast cancertreatment, but funds were needed to cover the costs of facilities,labs, imaging, and oncology services.

Twenty years later, the non-profit organization that was startedbecause of one doctor’s vision, has touched the lives of over130,000 North Texans. Today, the medical network includesover 200 providers, medical facilities, and community partners.During the 2010 - 2011 fiscal year, The Bridge Breast Networkmedical providers donated over $5.6 million in services to TheBridge clients. What started out twenty years ago as a profes-sional courtesy, is now an extensive medical network of dedi-cated professionals working together to provide uninsuredwomen in 16 counties with life-saving breast cancer and breasthealth services.

The Numbers Are Growing

Cancer is a growing health concern in the United States, andthe latest data shows breast cancer is becoming a critical healthproblem in Texas. The 2003 - 2007 Texas Cancer Registryshows that breast cancer led cancer diagnoses among women

in Health Service Region 3 at a rate significantly higher thanthe state average. Health Service Region 3 includes theDallas/Fort Worth area. There is a need for comprehensivemammography and follow-up programs to ensure womenreceive regular screenings and that those receiving a positivediagnosis receive treatment services in a timely manner.

The Bridge Breast Network has provided breast health educa-tion and awareness, access to breast cancer diagnostic andtreatment services and compassionate patient navigation serv-ices to over 130,000 North Texas residents with Health ServiceRegion 3 for 20 years.

Access to healthcare is essential to our lives and community.Preventative and routine healthcare access allows women andtheir families to stay healthy and take responsibility for theirwell being. However, for individuals who may lack knowledgeand/or access to financial resources, maneuvering the health-care maze is challenging and many times discouraging. TheBridge Breast Network provides vital services needed to ensureindividuals receive medical care and empowers them to makebetter healthcare choices.

Services

In 1993, The Bridge Breast Network served 50 clients withdiagnostic services and breast cancer treatment services. By

BUILD A BRIDGE,SAVE A LIFEby Terry Wilson-Gray

community news

2002, the number of clients had grown to 430 served. In 2011,The Bridge Breast Network served 2373 clients. 2011 statisticsshow that nine clients between the age of 13 and 19 were servedby The Bridge Breast Network; clients 65 and older totaled 36;and the majority (1388 of 2373) of clients served by The BridgeBreast Network were between the ages of 40 and 49. These2373 clients received services that include mammograms, sono-grams, breast MRI, biopsies, surgery, medical oncology, radia-tion oncology, and follow-up.

Vision

Women and men with breast cancer who lack financialresources will have access to medical services and a qualityclient experience. This is made possible through our expansiveand growing provider network, an increased operating budget,a cohesive marketing plan, and a sound fundraising strategy.

Mission

To save lives by providing access to diagnostic and treatmentservices for breast cancer to low income, uninsured, and under-insured individuals.

Why Support Matters

For every dollar donated, The Bridge Breast Network clientsreceive nearly 10 times that amount in medical care. Hundredsof physicians and medical facilities specializing in breast cancer

treatment either volunteer their services or drastically reducetheir fees in order to serve The Bridge Breast Network. In 2011,a grant for nearly $1 million from the Cancer Prevention andResearch Institute of Texas (CPRIT) was awarded to The BridgeBreast Network. This grant will be used to provide education,screening, and diagnostic services in six counties. Also in 2011,grants totaling $632,693 were awarded to The Bridge BreastNetwork by Susan G. Komen for the Cure Dallas, Greater FortWorth, and North Texas Affiliates. These dollars will providediagnostic and treatment services in eight counties.

Build A Bridge, Save A Life

In 2012, The Bridge Breast Network announced plans to gogreen! The 20th anniversary was celebrated with A Night In TheEmerald City at the annual Fly Away With The Bridgefundraiser in February. Along with the celebration of donor gen-erosity, and the dedication of medical providers, volunteers andstaff, The Bridge Breast Network is offering an invitation tothose who can help grow the current donor base, and sustainfundraising efforts by becoming a part of the 20 x 20 EmeraldClub: find 20 people to donate $20/month for 12 consecutivemonths. The goal of the campaign is $600,000 and an extendeddonor base for future generations of North Texans. For moreinformation, please visit www.bridgebreast.org or contactExecutive Director Terry Wilson-Gray at (214) 821-3820. n


Our only business is working with TDA Members and their sta� s.

We are committed exclusively to servicing TDA membership’s needs.

Let us review, compare and provide options for your coverage.

Protection is our Business

Bob Michaels, CLULocal Associate214-696-5103

B b Mi h l CLU www.tdamemberinsure.com 1-800-677-8644

Disability Life Health Long Term Care Malpractice


Spina Bifida is the most commonpermanently disabling birth defectin the United States. It occurs

when the spinal cord fails to close duringthe first months of pregnancy. SpinaBifida causes abnormalities of the brainand spine resulting in life-long disability.More than 250,000 Americans live withSpina Bifida every day.

SUPPORTING A GREAT CAUSE

The goal of Spina Bifida Association ofNorth Texas (SBANT) is to raise aware-ness of Spina Bifida and give children,families and adults the tools they need tobe advocates for themselves, independentand active individuals with Spina Bifida,and to have a strong, supportive commu-nity. The organization promotes the pre-vention of Spina Bifida and enhances thelives of all affected by SB.

The activities sponsored by SBANT helpmake it possible for families with chil-

dren to gather and exchange ideas. It isespecially beneficial for children with SBto meet other kids like them.

In addition to hosting a holiday party inDecember, SBANT holds an Easter EggHunt and a picnic for families withyounger children during the year.Parents frequently get together andlong-lasting friendships have beenforged between parents and children.

Each June, SBANT sponsors a six-dayresidential camp at Camp John Marc, abeautiful, accessible camp located inMeridian, Texas, about 75 miles south ofthe DFW area, for children with SpinaBifida ages 8 to 15. Doctors and nursesfrom the SB clinic at Texas Scottish RiteHospital for Children organize andsupervise the medical care provided atcamp. The campgrounds have beendesigned to be completely accessible,and are home to a state-of-the-art thera-

peutic camping facility with a speciallytrained staff. Days at camp are filled withswimming, boating, fishing, horsebackriding, arts and crafts, photography,dance, singing, sports and games andother fun activities. This is an excellentopportunity for parents to allow theirchild with SB to experience greater inde-pendence, and to meet other kids facingthe same challenges.

SBANT also sponsors two family campseach year at Camp John Marc. In thespring, our Spanish-speaking familiesgather for a weekend of fun, relaxationand sharing. Some child care is providedso that parents can meet and discussimportant health and other issuesrelated to the challenges of life with SB.

In the fall, SBANT holds a weekendcamp geared for families with childrenunder eight years of age. Fishing, hiking,arts and crafts are offered.

2012It’s time for the Annual Bowl-A-Thon to benefit the Spina Bifida Association of North Texas. We invite you to have fun and help support the great things SBANT does for kids and families in our community!

This is a great opportunity to build camaraderie with your co-workers, get competitive with your friends, and entertain your family – all while supporting a great cause!

2012

community events

Building Relationships

www.structures-interiors.com 817.329.4241

“I found Structures and Interiors’ staff of construction professionals extremely easy to work with. Structures and Interiors did a wonderful job designing my office and building it out in an amazingly short time period for this type of detailed construction. I am very pleased with their work and their always pleasant attitudes and eagerness to get things right and in the exact way I wanted them.”- barrie barber choate dds, msd, pa pediatric dentistry

[email protected]


TO START OR JOIN A TEAMREGISTER ONLINE AT:https://spinabifidant.myetap.org/fundraiser/sbantbowlathon2012/

Fundraising Goals: Individual $125 or Team $625Door prizes, prizes for top fundraisers and more! Rewards for meeting and exceeding goals!

Early Bird Registration:Pay registration fees by April 1st and get a bonusdoor prize ticket! $25 registration fee per bowler.Includes event t-shirt, lunch, one game of bowling(more if time and space allows) and goody bag.

International Bowling Center & Museum621 Six Flags Drive in Arlington, TX

For location information and maps, visitbowl.com/itrc and bowlingmuseum.com

This fundraising event includes:n Family and Team Bowlingn Entertainment & Activities for all agesn Lunchn Awards & Prizes for Top Fundraisers

& Team Goal Accomplishmentn Door Prizes for Participants

SBANT BOWL-A-THON2012 Saturday April 28th 11:00am to 3:00pm

TWICE THE FUNThis spectacular event includes both thebowling and museum facilities. Experiencethe history of bowling in a fun, interactivemuseum and bowl in a state-of-the-artprofessional training facility, all while rais-ing funds to support the programs andservices of SBANT!

WE WELCOME YOUR DONATIONYou can also simply donate to the Bowl-A-Thon goal directly or search for partic-ipants and donate toward their goals.Sponsorships and in-kind donations areneeded as well! SBANT appreciates andacknowledges all levels of donation. As a501(c)3 non-profit charity, your donationis tax deductible. Make your paymentsecurely online via our website or mailyour check directly to our office at 705 W.Avenue B., Suite 409, Garland, Texas75040. Without the support of companiesand individuals, we would not be able tofulfill our mission.

VOLUNTEERS We welcome both corporate and individ-ual volunteering. As an organization thatrelies on volunteers for most of its pro-grams and services, we need you! Visit thewebsite to explore opportunities to volun-teer and find more information:

www.spinabifidant.org

International Bowling Center & Museum in Arlington, Texas

(CONTINUED FROM PAGE 5)

Research and education are inextricablylinked to the practice of dentistry,”D’Souza says, which brings her to anothergoal: seizing the opportunity to work withGlickman, a longtime friend and col-league, on key issues pertinent to bothorganizations.

Most recently, D’Souza oversaw the organ-ization of the 2012 AADR Annual Meetingand its activities. During the four-day session, she had the opportunity to intro-duce some of the organization’s newestinitiatives.

Dr. Gerald Glickman

It’s a Monday in mid-February andGlickman, on the heels of a two-day read-

justment following his return trip fromSaudi Arabia – where he was one of thefeatured speakers at the King Saud 14thInternational Dental Conference – is backin full swing in the college’s endodonticsdepartment.

On the cabinet above his desk is a diorama that reads “Landscape of Learning:2013 ADEA Annual Session andExhibition.” It bears the image of a tree,and above its branches, in the shape of an arch, are the words ‘reflection, interpro-fessional education, assessment and inno-vation.’

Glickman elaborates on its meaning. “Myfocus is two-fold,” he says. “The focusessentially will be on lifelong learning andself-reflection. With current students, this

means how do we instill in them the life-long skills they’ll need once they leave?

“We as a profession are concerned aboutlearning once students leave their institu-tions. We want to provide the tools thatmotivate students to continue to learn.”

The second focus: working to createvibrant, proactive ADEA student chapters.This means establishing chapters at dentalschools without them and further develop-ing those that are already in existence.Currently, TAMHSC-BCD has several den-tal and dental hygiene student delegates to ADEA.

“Since students represent the majority ofthe membership of ADEA, we really wantto focus on how we can make ADEA moreuser-friendly for them and help guidethem towards careers in leadership, aca-demics and research,” Glickman says. n

Jennifer Eure Fuentes is a communicationsspecialist at Texas A&M Health ScienceCenter Baylor College of Dentistry. A 2006graduate of Texas Christian University, shehas worked in the communications and edito-rial field for five years.

Founded in 1905, Baylor College of Dentistry inDallas is a college of the Texas A&M HealthScience Center. TAMHSC-BCD is a nationally rec-ognized center for oral health sciences education,research, specialized patient care and continuingdental education. The TAMHSC serves the stateas a distributed, statewide health science centerthat is present in communities throughout Texas.


The 2012 TEXAS Meeting is fastapproaching! Join your fellow Texansfrom all over the state as they head to

San Antonio for the largest dental meetingin Texas! In the Lone Star state we havebecome accustomed to the phrase “Biggerand Better” and that is no exception whenit comes to the TEXAS Meeting. You andyour staff will have opportunities to choosequality continuing education, networkwith colleagues, and shop at the largestexhibit hall in Texas. Treat yourself andyour staff to an exciting and rewardingthree days in beautiful San Antonio for theTEXAS Meeting.

The Council on Annual Session hasplanned an incredible dental meeting foryou. At the TEXAS Meeting you and yourdental staff can fulfill all of your state CEdental requirements. Take advantage ofone of your incredible TDA member bene-fits – no conference pre-registration fee foryou and your staff. If you are not a TDAmember, come see what the TEXASMeeting is all about for a one-time onlyspecial conference pre-registration fee of$75, instead of $995 – details available attexasmeeting.com.

The TEXAS Meeting is proud to present awide array of 95 nationally recognizedspeakers. The speakers will present dentalseminars, certification classes, and partic-ipation workshops for the entire dentalteam. Topics will include Cosmetics,Restorative Dentistry, Pediatrics, Implants,Lasers, Periodontics, Endodontics, OralSurgery, Occlusion, Practice Managementand much, much more. But the fun is juststarting.

More than 350 exhibitors have been con-tracted and are eager to share informationon “Bigger and Better” dental productsand services. The TEXAS Meeting exhib-itors provide a variety of meeting specialsand the latest technology for you and yourdental practice. The bustling exhibit hallwill have many activities taking place dur-ing the meeting. Visit the special artist whodigitally sketches a portrait of you andyour friends, bid on a unique item at theDENPAC Silent Auction, learn about yourpractice opportunities with TDA Perks,and check-out the many charitable eventssupported by the TDA Smiles Foundation.After your classes and workshops, unwindat the Thursday and Friday happy hours

where you will enjoy complimentary beerand wine in the exhibit hall from 4:30 p.m.to 6:00 p.m.

Thursday evening showcases the famous“Texas Party” with live entertainmentfrom the band “The Klocks”. Come kick up your heels with complimentary foodand beverages at this social event, plus a cash bar. Remember your TEXAS Meetingbadge is your entry to the party.

What a great festive agenda set in the back-drop of the scenic San Antonio Riverwalkand the historical Alamo. Come enjoy the“Bigger and Better” TEXAS Meeting, May 3-6, 2012!

Please visit texasmeeting.com for moredetails or contact Donna Musselman,[email protected], Ann Pargac, [email protected] call (512) 443-3675. n

Bigger and Better in Texas!

THE TEXAS MEETING 142nd Annual Session of the Texas Dental Association Henry B. Gonzalez Convention Center, San Antonio, Texas

May 3-6, 2012

THE TEXAS MEETING



money matters

A s a result of rising medical costs and health insurancepremiums, many have increased their deductibles andcoinsurance or eliminated such features as office or

prescription drug copays. Healthcare Reform has not changedthe cost curve, and the uncertainty about national healthcarewill probably not be resolved until after the 2012 elections.What are some options that may help with potential costs and alsosave you some money? Here are some you may want to consider:

Qualified High Deductible Health Plan (HDHP)with a Health Savings Account (HSA)

This is a health insurance policy that pays medical expenses,including prescription drugs, only after the deductible has beenmet. These plans are designed to give you a lower premiumwhile protecting you from catastrophic claims. As a result of thePatient Protection and Affordable Care Act the following man-dated benefits are now included: no lifetime benefit limits(based on dollar amounts); first dollar preventive care for essen-tial benefits – including physicals, well woman exams, well childcare, and immunizations – all without an office visit copay ordeductible if they are done in-network; no restricted annual lim-its (on the dollar value); and dependent coverage up to age 26.

Anyone under age 65 is eligible to establish an HSA, providedthere is a Qualified High Deductible Health Plan in place, andno coverage under another health plan. And although you arenot required to contribute the maximum amount per year, oreven make a contribution, this is almost too good an opportu-nity to pass up. For 2012, the maximum contribution allowedis $3100 for an individual plan and $6250 for a family plan.Contributions not used for medical expenses during the yearcan be rolled over to the following year – it’s not “use it or loseit” as it is in healthcare flexible spending accounts. Personsbetween the ages of 55 and 65 can make additional “catch up”contributions of up to $1000 a year for 2011 and later.

Contributions can be made as late as April 15th of the followingtax year.

What you don’t use from the HSA each year is yours to keep.The balance continues to grow on a tax-sheltered, compoundbasis. Once you reach age 65, the account can basically be usedlike a traditional IRA, but is not subject to distribution limita-tions or penalties and distributions for eligible expenses are stilltax free. And, just like an IRA, upon death the funds in the HSAcan be transferred to a beneficiary. If the beneficiary is a sur-viving spouse, the transfer is tax-free. As with any tax issue,always check with your CPA or tax professional to make surethis makes the most sense for your particular situation.

Critical Illness Insurance

Critical Illness insurance pays a set amount to the insured whena qualified event occurs. Critical Illness insurance typically pro-vides the full policy benefit in a lump sum payment upon diag-nosis of a critical illness listed in the policy, such as heart attack,stroke, cancer, Alzheimer’s disease, or organ transplant.

There is no coordination of benefits with other health or dis-ability insurance. The money can be used to pay medical bills,cover a mortgage, or anything else you want. You are in com-plete control of how the funds will be used. Critical Illness insur-ance bridges the gap between the health insurance policy andthe actual expenses incurred. Premiums for Critical Illnessinsurance are normally between $25 and $50 per month foraround $25,000 of coverage, so it is a way to provide some addi-tional protection at a low cost.

Discount Prescriptions & Other Savings Plans

Everyone likes to save money. You can maximize your savingsby using discount programs offered through most pharmacychains or through professional associations like the TDA. Whenyou purchase prescriptions, simply visit a participating PPO dis-

By Bob Michaels, CLU

Saving Money on Healthcare

count pharmacy (most major chains participate) and pay thediscounted amount on the spot, either by debit card or checkdirectly from your HSA. For greater savings, use the bulk pricedRx mail service, use generic or over-the-counter meds or pillsplitting when appropriate to get more meds for the dollar.

There are other discounts cards available that for a low monthlycost, gives you access to discount medical programs offering sig-nificant savings from healthcare providers across the nation.These include: vision products and services (including glasses,contacts and even LASIK surgery), chiropractic care, lab andimaging services, diabetic supplies, vitamins and many otherproducts. Also offered through professional associations like theTDA, is the Teladoc service, which is a national network of boardcertified physicians who use electronic health records, telephoneand online video consultations to diagnose, recommend treat-ment and write short-term prescriptions when appropriate.Teledoc physicians are available 24 hours a day. There are nowaiting periods or restrictions on these plans and for less than$20 per month you can have access to a range of discount prod-ucts and services for the whole family. This is also an inexpensiveemployee benefit so keep it in mind for your staff.

Like most things, there is not one right answer. However, thereare ways to save money on premiums and health care expenses.Insurance is about managing risk. By increasing your deductible,or utilizing an HSA with a High Deductible Health Plan, and

supplementing this with other types of coverage and discountedproducts, you can save on your premiums and still be coveredin the event of a big claim.

If you would like to receive more information on any of these pro-grams for you, your family, or office staff, please contact me at (214) 696-5103 or email me at [email protected] visit our website at www.TDAmemberinsure.com. n

Bob Michaels, CLU has been in the in-surance business in Dallas, Texas forover 40 years. He has been an Associ-ate with the TDA Financial Services In-surance Program for the last eightyears. Bob’s scope of operation in theTDA Insurance Program includes life,health, disability income, employeebenefits, long term care, and malprac-tice insurance.

For more information, visit www.TDAmemberinsure.com. You can contactBob at [email protected] or call (214) 696-5103.

Case PresentationsProvided by Leading Doctors in North Texas

SMILESin theSPOTLIGHTn High Resolution Photographyn Step by Step Details of Treatment

North Texas

Dentistry

For more information on sharing your expertise in a future Smiles in the Spotlight contact

[email protected] 214-629-7110

SMILES IN THE SPOTLIGHT CASE PRESENTERS DO NOT PAY A FEE FOR INCLUSION IN THIS FEATURE



Ever since the dental profession began setting up shop insolo practices over 100 years ago, doctors have wrestledwith the never-ending and exhausting demands of run-

ning a successful practice. Not only do modern dentists bear thelegal and ethical burden of providing the very best possible clinicalcare for their patients, but they have all of the peripheral practiceissues to deal with — hiring and retaining the right staff, compen-sation issues, insurance company interference, managed careinroads, marketing, regulatory compliance, web site development,facility issues, employee conflict, computer systems, continuingeducation, practice financing, collections, federal and state taxes,case acceptance, associate concerns, rising operating costs, labwork that is substandard, equipment maintenance and repair,embezzlement, etc. The list of ongoing responsibilities and con-cerns for the sole practitioner is practically endless, and the toll all

these issues take is heavy. No wonder most dentists report workingchairside less than 34 hours per week—they’re exhausted!

And let’s face it, dental practice today is far more complex than itwas even 10 or 15 years ago. Costs are higher; fees are under con-stant pressure; insurance plans more diverse and difficult tounderstand; employees more demanding; regulatory compliancemore daunting; and patients more difficult. And now with the pro-liferation of well-funded corporate DMSOs, competition is intenseand patients more scarce. With all these headwinds, it’s no wonderso many dentists are looking for real solutions.

One solution that has gained considerable notoriety of late is thecorporate-sponsored DMSO model. Love them or hate them, theseorganizations present a compelling value proposition to a profes-sion that is stressed out and worn down by all the rigors of solopractice. Essentially, they offer the promise of relief from all thenon-clinical concerns that solo doctors face on a daily basis. In theDMSO model, doctors focus on clinical care and treatment, whileother business related tasks and obligations are delegated to busi-ness professionals. When this model works, it works well —although at a very high cost to the doctors. DMSO’s have a longand rather impressive track record of growing revenues and low-ering costs in the practices they acquire.

Just how well these professional practice managers have per-formed will likely come as a surprise to most solo doctors.Overhead in a DMSO practice can easily drop to 50% or less dueto leveraged purchasing power and other economies of scale.Annual revenues per location also average $500,000 higher thanin the typical non-managed solo practice. Higher revenue andlower costs provides considerable advantages to these profession-

The Case for PROFESSIONAL MANAGEMENT

by Kirk Huntsman

practice trends

ally managed practices. Unfortunately, inmost DMSO business models, the corpora-tion that creates this added value also endsup with the lion’s share of the profits. Andwhile such impressive performance may begreat for the DMSO and their Private Equityshareholders, what about doctors who pre-fer to remain independent?

What if independent dentists could realizethe same kind of practice performance thatthe DMSOs deliver without resorting tohaving to sell their practice and lose con-trol? Until recently, that really wasn’t anoption. Now, however, solo doctors andsmall group practices can access the verysame caliber of world class resources, train-ing, and performance strategies employedby the large corporate groups — and all at avery reasonable cost.

Let’s take the typical dental practice gross-ing $700,000 per year with a 67% overhead. That doctor will net about$231,000 per year. Now, let’s say she hiresa ‘virtual DMSO’ management firm (onethat doesn’t require ownership) to come inand help her improve and grow her busi-ness. They would first evaluate her prac-tice to see where the opportunities forimprovement might exist, then begin a tar-geted approach to re-train, re-direct, andgrow the business. It’s not unusual for doc-tors to see immediate and lasting improve-ment in areas where they thought theywere doing everything possible. One suchdentist recently wrote that after just twodays of training, his hygiene departmentwas on pace to produce an additional$311,700 this year! Moreover, his patientswere delighted with the improvement incare and service, and his team was moremotivated than they’d been in years.Typically, in a professionally manageddental office, operating costs drop down toaround 55% or less, as lab, supplies, labor,and fixed costs all drop due to leveragedpurchasing power and higher productivity.

As with everything in life that is worth hav-ing, these practice gains come with a price.In most cases, the costs range between 3%and 9% of gross revenues, depending onthe degree of involvement. But even on thehigh end of the cost range, the net to the

owner/doctors can be substantial. In thepractice cited above, the doctor should earnan additional $160,000 this next year, afterall fees to the management company (at thehigh end of the range). That math works.

None of what I’ve just described is magic.For those who know how, it’s just what hap-pens when sound business principles andbest practices are consistently applied by

professionals who know what to do. If yourpractice isn’t performing the way you’dlike, or if your income from dentistry isn’twhat you’d hoped for, it may be worthlooking into getting some professionalpractice management help from a com-pany that can do far more than cheerleadfrom the sidelines. n


R. Kirk Huntsman has been active in the dental industry for over 23years. In 1988, he became the Dallas/Fort Worth licensee for AFTCOAssociates, a dental practice brokerage company with over 65 officesnationwide. Within two years, his was the top performing office in thenation. In 1991, he acquired the Houston license and continued to rap-idly expand. By 1995, he was ready to begin owning and operatingpractices, so he launched Dental One as a dental management serv-ices organization, or DMSO. Under Mr. Huntsman’s leadership anddirection, Dental One (now Dental One Partners) grew from scratchto over 150 offices in 14 states.

After leaving Dental One Partners in the spring of 2010, Kirk beganworking closely with Morgan Stanley Private Equity in their acquisition of ReachOut HealthcareAmerica, the nation’s largest mobile dentistry provider. Mr. Huntsman recently left ReachOut inorder to form Nexus Dental Group, a virtual DMSO providing a wide range of DMSO-type re-sources and services to independent dentists.

Mr. Huntsman is a 1981 graduate of Brigham Young University’s Marriott School of Management.


SATELLITE ECONOMICS

by Richard V. Lyschik, DDS, FAGD

Y our practice is not growing as fast as you’d like, or perhapsyour practice has reached a production plateau and there

are not any indicators that growth is about to happen again any-time soon. You are working four days a week, but when you lookat your schedule you realize that you actually could do all of thisproduction in two or two and a half days each week. Your staffneed their full time jobs, so they just continue to let the patientsdecide what day of the week to come in for treatment and youend up spreading two or two and a half days of treatment overfour or five days.

You’ve talked to some of the other dentists in town and manyof them have the same complaints – too much open scheduletime and not enough patients to fill it. As a result, the overheadpercentage for your practice continues to increase while pro-duction drops because most of your expenses are fixed. The lessmoney you take in, the higher the overhead becomes as a per-centage of that income. Higher overhead and lower net incomemay have you thinking, “Do I do something about this now, orignore the signs and go down with a slowly sinking ship?”

Practice mergers are always the best answer, because they offerthe best fix to this declining revenue problem (actually the onlyfix). Buying and merging a nearby dental practice can immedi-ately increase your patient flow and patient revenues. Most ofyour existing practice expenses are fixed (including staff salariesin this case), so two thirds of the additional patient revenuesfrom the merged practice represent net profit for the purchaser.A practice merger is the best investment a dentist could everhope to make in his/her practice lifetime.

But suppose you live in an area where there are no practicemerger prospects, what do you do? Time is money. The doctoris the Number One income producer for the practice and if thedoctor has down time, then the doctor is losing money. The nextbest thing to a practice merger then is to purchase an existingpractice in another area and operate it as a satellite office. Youwill not need to hire the staff of the acquired practice, whichsaves you one-half of the overhead costs of the average practice.Your current staff will run both offices (forwarding telephonesand appointment scheduling, etc.), which will represent a sub-stantial overhead savings.

Your current staff will need to take better control of schedulingso you can see all your patients in two or two-and-a-half daysper week in your current office and the same number of days inthe satellite office. You can alternately be available to yourpatients four days a week for each office with a custom ThreeDay Overlap Scheduling Program. It will just depend on whichweek you are at which office.

Depending on the total active patient count of both practices,acquiring a satellite office could also present you with an oppor-tunity for adding an associate to your now two-office practice.It’s possible you could establish an order of succession for your-self when you wish to retire in the future, and you could evenpull out a significant amount of cash from your existing practicewhile maintaining ownership.

Time lost is money lost, and you need to get busy and stop los-ing money. Accelerate your retirement plans with SatelliteEconomics. n

Richard V. Lyschik, D.D.S., FAGD is one ofAFTCO’s leading innovative Senior Analystswho has helped over 2,900 dentists inassociating, buying, expanding, or merging andguided older, disabled and/or “burned out”dentists to sell their practices. Dr. Lyschik’sclients have seen the considerable benefits ofincentive programs, pension funding plans andincreased productivity through his guidance.There is no substitute for experience in thisbusiness. Who better could you choose to talk

to about your future transition plans than a seasoned fellow dentist, a recognizedpremier transition expert, and AFTCO Analyst of the Year Award winner? Checkout the impressive AFTCO website at www.AFTCO.net, then call for a freeappraisal and a no-obligation consultation with Dr. Lyschik at your office or theAFTCO office in Dallas, TX at (214) 893-0410 or 1-800-232-3826.

Accelerate Your Plans For Retirement

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Their nationally acclaimed program isinnovative, compassionate, and cost effec-tive. Last year Bryan’s House served over1,100 clients, 350 of them children in theirchild care programs. Over and over again,clients say that Bryan’s House is differentfrom other agencies because they are therenot only for the children, but the entirefamily, many of whom have no place elseto go for the services they need. n

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Dental Keynote Concepts .........................................5

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All seminars are 7:00 to 9:00 p.m.Cost $95 Registration begins at 6:30

Omni Hotel1300 Houston StreetFort Worth, Texas 76102

Sheraton Arlington Hotel1500 Convention Center DriveArlington, Texas 76011

April 10

May 8

Are overhead costs draining your profits?

LIMITED TIME OFFER:Confidential FREE analysis of YOUR practice overhead

This No-Cost, No-Obligation, Personalized Overhead Analysis isperformed by professional practice managers at Nexus who know all aboutpractice overhead. After all, we have actually operated HUNDREDS ofpractices on a national scale at an average overhead of around 50% (pre-doctor comp).

• Learn how your practice overhead stacks up to key national and local benchmarks.• Learn the 4 essential keys to lowering a typical practice overhead,increasing personal income by an average of $70,000 to $100,000.• Learn how to drive supply costs down by 20 - 40% or more.• Learn how to cut your lab bill 40 - 60% without compromising quality.• Learn why “FIXED” costs don’t have to be “FIXED” after all.• Learn how large corporate DMSOs drive their practice level operatingcosts to 50% and better!

NEXUS DENTAL ALLIANCE is committed to helping private practitionersacross the country experience a whole new way of practicing. The Nexuspractice model features higher revenues, lower operating costs, and theprospect of high levels of PASSIVE INCOME from dentistry. You owe it toyourself to see what you’ve been missing.

LEARN MORE ABOUT US Register for an upcoming seminar:

LIMITED SEATING - REGISTER TODAY!

Call (817) 328-6150 or visit www.nexusdentalalliance.com

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North Texas Dentistry Volume 2 Issue 3

Documents

Transcript of North Texas Dentistry Volume 2 Issue 3