Tag Archive for: setting up dental practice

Hello and welcome to Ascent Dental Radio. A program dedicated to the balance between the clinical aspect of health care and the business of health care. And now here is your host, Dr. Kevin Coughlin.

Kevin: Good afternoon. This is Dr. Kevin Coughlin and you’re listening to Ascent Radio. This podcast is brought to you by Ascent-Dental-Solutions.

I’d like to start every podcast with special thanks to Mr. Doug Foresta. His company, Stand Out and Be Heard, has been participating in over 75 podcasts. And without his expertise and his business acumen, this podcast would not be possible.

I also would like to give special thanks to the VOCO Company. They have been supplying over 40 years of dental supplies and products to the dental community.

They’re a worldwide company and have headquarters in Germany and their headquarters in South Carolina, and a special thanks to VOCO for their expertise and supporting this broadcast.

This afternoon, we have three guests. The Kellogg Foundation is a foundation that is almost totally devoted to improving oral health for our most vulnerable population. And that’s the young children under the age of 18, but particularly, those most prone to dental disease under the age of ten.

This foundation has been providing services, finances and expertise and looking for solutions to improve this epidemic situation, which is dental caries and dental disease, primarily in our younger population, and primarily the population that’s underserved in need of the greatest assistance.

Today, our guests are Dr. Mary Willard, Ms. Sarah Wovcha and Dr. Terry Batliner. The three of you, thank you so much for your expertise and knowledge in the subject of improving the situation. And special thanks again to The Kellogg Foundation for their effort and expertise in this area. I’d like to start with Dr. Willard. Mary, what do you think is the most significant problem for dental education and dental care in this particular population?

Mary: The biggest issue is access to care, I believe. We have many populations living in inner cities that have trouble getting appointments with dentists. Sometimes in places like where I live in Alaska, it’s because there are very few dentists in our remote villages and communities. Sometimes in inner cities it’s because the dentists don’t accept Medicaid or uninsured patients.

Kevin: If you had the ability to snap your fingers tomorrow, with your expertise, knowledge and background, what would you say would be the single best solution, in your opinion, to improve the situation?

Mary: I don’t think there’s one single thing that we can do, but one very effective tool is to implement the use of dental therapists in our dental teams to expand access to underserved populations.

Kevin: Sarah, if I was to ask you the same question, is there anything you’d like to add or delete to those recommendations of Dr. Willard?

Sarah: No, I think Dr. Willard has hit the nail on the head. Those are precisely the issues that we face in Minnesota.

Kevin: Dr. Batliner, with your expertise and background, is there something you’d like to add or delete or do you think that’s the significant problem and that’s perhaps one of the strongest options or solutions?

Terry: Sure, let me just define the problem a little bit more. I live in two worlds. I have three dental practices in Boulder, Colorado and around Boulder and I also am the associate director for The Centre for Native Oral Health Research at The University of Colorado where we conducted research on Indian reservations.

There really are two types of problems and Mary touched on them quickly. One is that there’s not enough providers who take Medicaid. In my role in Boulder, I’m a Medicaid provider and there aren’t very many Medicaid providers, even though the compensation is pretty good in Colorado.

And then in my role as a researcher with native communities, we see that the dentist to population ratio, which averages 1:1600 in the United States, on reservations such as Pine Ridge in South Dakota and the Navajo Nation in Arizona and New Mexico has a dentist to population ratio of 1:4000 or worse than that. So it’s very difficult for people to access care.

In combination with that, in places such as native communities or in the Medicaid population, the amount of disease is much higher. And so we find that kids three years old, perhaps in Navajo at age three, 70 percent of those kids have untreated decay. On the Pine Ridge Reservation, about 55 percent of those kids have untreated decay in our latest data. So there’s a lot of issues.

We also found that the Hispanic Medicaid population in the Metro Denver area is comparable with their degree of disease to the kids on Pine Ridge. About 55 percent of kids have untreated decay.

Kevin: I thank the three of you for that feedback. I am a practicing dentist. I still practice. I was actually in my office practicing since 7:00 this morning and I deal with all different populations. My practice is fairly large. We see on an average of about 116, 000 patient visits a year and I am quite familiar with the problem.

Since we have a variety of listeners, in your opinion Dr. Willard, what would you say the dental therapist for those who may not be up on the topic, they may not be as informed or educated, and sometimes there’s misinformation.

My personal opinion here on the East Coast, but particularly in New England, you have two schools of thought. One school of thought is they’re very much against these mid-level practitioners, these dental therapists, these expanded duties. And my personal opinion, it may not be accurate, but my personal opinion is many in the dental community find this as a threat.

If we do the SWOT analysis — Strength, Weaknesses, Opportunities and Threats — they perhaps are concerned that there’s a threat to their business and to their income. Other individuals may be concerned with quality of care, the ability to monitor the quality of care. Could you address those issues and perhaps sway the listeners how those potential issues could be misguided?

Mary: Basically, the dental therapist is a primary care provider, new team member who brings additional services and brings a different team player to the dental office. What we have is a provider who is able to provide basic restorative, preventive services and is typically from the community.

For me, that’s the big aspect of what this dental provider brings, is a familiarity with the customs and needs of the community they’re serving, especially when they come from that same community. It’s a way to provide care closer to home and also having a therapist on board is a way to provide patient navigation services as well, so services that are out of the scope of a dentist.

What we see in Alaska right now is that the dental therapists are able to provide the basic restorative and preventive services that are needed and then they can provide referrals to the dentist for the higher level care. As a result, we’re seeing that the dentists are able to perform more of the higher level services and are not spending as much time on the basic restorative.

So what you’re going to have as a dentist working with a therapist is an increase in your production, especially in those higher levels like partials, dentures, implants, crowns and visits because you got that fixed during the restoration. We’re finding that it’s increasing the bottom line for the dental practices as a whole.

Kevin: And that’s possibly a motivation to move the dental profession perhaps in a more positive direction. Ms. Wovcha, Sarah, if you were to add or comment to Dr. Willard’s assessment, would you agree, disagree, add or delete anything?

Sarah: I agree with Dr. Willard’s assessment. I would also say that if we look at the facts in terms of not only the training, but what we are seeing when dental therapists are engaged in a practice, they bear out that they are quality, efficient providers. To give a specific example of that in Minnesota, dental therapists at our training programs in Minnesota are educated side by side with dentists. When they become licensed, the exam that they undergo is in a blind setting.

In other words, the evaluators do not know whether they are evaluating a dentist or a dental therapist for the procedures that they are assessing. So it’s completely competency based. Again, they’re trained with dentists at the same institutions and they are evaluated in the same way in a blind setting.

I think the difference is that dentists are trained to do around 500 some procedures in Minnesota, for example, and dental therapists are trained to do about 50 some procedures.

So they are learning in-depth how to do these less complex restorative procedures and they’re gaining a repetitive skill set. If you just look at the sort of objective external factors of the training and the assessment, it bears out that they are competent and at least at the same level of quality as dentists.

Then when we look at how they actually perform in practice, the State of Minnesota Department of Health has done an assessment of all licensed dental therapists and have found that they are productive in practice and there have been no confirmed incidents of malpractice since they have been licensed in our state. Again, there are very objective metrics that show quality, efficiency and expanding access to care.

Kevin: Dr. Batliner, is there anything you would like to add or comment or delete from the previous two experts? Is there something that you’d like to present to our listeners?

Terry: Sure, I think the quality has been studied. Dental therapists have been studied more than any other type of providers in the last ten years and have been shown to provide quality comparable to dentists doing the procedures that they perform, which is a smaller number than dentists. I think the other thing to consider is that they can operate more cost effectively.

For example, in my practice, I pay our associates 30 percent of collections. So let’s say they do — just to make it easy — $300 an hour, so they get paid about $90 an hour.

We hire hygienists in Colorado. We pay them quite a bit in Colorado, around $40 an hour. It’s reasonable to think that I could hire, if they were legal in Colorado, a dental therapist for somewhat more than a dental hygienist. I think that’s what Sarah has found in Minnesota.

So let’s say we pay the dental therapist $45 to $50 an hour and then they can do, in our studies of their performance around the country, around 75 or 80 percent of the things that people need when they walked in the office. So it’s a cost effective arrangement. It would allow more offices to provide care to underserved groups that may be parts of programs such as Medicaid that pay based on a discounted fee schedule.

Kevin: Dr. Batliner, I’m going to do a follow up question with you. If we could snap our fingers and based on the information and data, there’s roughly 500,000 dentists in the United States at any given time. And my understanding is that roughly around 200,000 to 250,000 are actually practicing fulltime. If we could snap our fingers and create another 250,000 dental therapists tomorrow morning, what would be the motivation to have those individuals go to the population in the locations that we need?

Is there a solution or a discussion that The Kellogg Foundation and the experts in this area are looking into? Let’s just say a miracle happens tomorrow, we’ve reached through the political quagmire and we’ve got these hundred thousand plus therapists, how do we get them to the areas that we need?

Terry: The first thing is we have to recruit them from those areas. As Mary has learned in Alaska, by recruiting people from the villages and they’re trained quickly in somewhat between two and three years, where they don’t lose touch with their home community and then we found that they return to their communities. That’s number one. Number two, if you want to involve more people of color, socio-economically disadvantaged people in the education system, you have to keep it as inexpensive as possible. Because it’s difficult for people to borrow hundreds of thousands of dollars and then pay that back, as many dentists have to do.

Keeping the training as short as possible, CODA, the Council on Dental Accreditation, has kept it at three years after high school. I think that’s good. The programs need to be cost effective and quick, and that will involve more people. I think those are really the issues; recruit people from the communities, keep the training as short as possible and as inexpensive as possible so that the people we need to get trained can get trained.

Kevin: Ms. Wovcha, Sarah, let me ask you a follow up question in regards to this situation. These therapists, how would they be compensated? Do you see this as they would be compensated not only through maybe a clinic such as Dr. Batliner owns, or do you see this as a State or Federal government sponsored, and they would be compensated for their services and their education through tax dollars in some shape or form?

Sarah: What we are seeing in terms of actual practice is that they are compensated as a credentials provider with medical assistance and private insurance as well. So they’re compensated in the same way that other dental providers are compensated.

We’re also seeing that they’re eligible for loan forgiveness, for example. So they are receiving in Minnesota, for example, some government dollars and there are actually private foundations that are helping to offset the cost of education. Is that answering your question?

Kevin: It is. Part of it is selfishly, I’m embarrassed to say that I’m not as well educated in that area as I should be. I’m assuming, like Dr. Willard working in the Alaska area, there are limited number of private practices. So I’m thinking out loud now on this podcast, is the therapist coming from the community would potentially have their own facility because there’s not enough dental facilities and is there an issue or a problem? Again, in full disclosure, I personally am 100 percent for expanded duties and always have been. I think it creates competition, it provides better access to care.

And selfishly from a financial stand point, I think most business people, particularly in dentistry, realize that a dental assistant provides an enormous increase in income and so does a dental hygienist and so do dental associates. So from my simplistic point of view, why wouldn’t dental therapists also? And I think Dr. Willard touched on those bases.

But in the areas where there’s just not enough dental facilities, do you see any issues or problems with these therapists striking out on their own to create more environments for the populations to be treated?

Sarah: I don’t see problems with that. In fact, the model is well adapted to be able to expand access in regions that don’t have dentists or don’t have traditional facilities.

Let me give you an example, again, speaking from the perspective of Minnesota. In Minnesota, dental therapists can practice in any setting in which there are 50 percent or more patients on medical assistance or uninsured patients in poverty. That can be a private practice setting, it could be a community clinic, it could be a mobile dental clinic, a hospital, a school based setting. There’s a large array of settings in which they can practice.

They must be in a relationship with the dentist. In other words, they must have it’s called a collaborative practice agreement, so that they can have a level of supervision by a dentist. But they are able to work independently.

In other words, in a large state, a dentist could be practicing in Saint Paul, Minnesota and the dental therapist could be five hours away in the wilderness in Ely, Minnesota practicing. So they’re certainly well situated to do that, and they are, in fact, doing that.

Just to give an example of distribution of dental therapists compared to dentists in Minnesota, our most underserved regions are our rural regions. And according to the study of the Minnesota Department of Health, right now 74 percent of dentists practice in urban settings and only 26 percent practice in rural settings. And with dental therapists, the numbers are almost double in rural and significantly less in urban.

So 47 percent of dental therapists practice in rural regions and 53 percent in urban. So we’re seeing better distribution of dental therapists that reflects the community in need.

The last thing I would say that Dr. Batliner touched on is that the way that we compensate dental therapists in Minnesota is much more sustainable for a clinic. For example, on average, a dental therapist in Minnesota receives $45 per hour and dentists receive $75 per hour. If you calculate the savings for a clinic, and this is really quite a conservative estimate.

If they see around 1,500 patients per year and I’ll say that the providers I employ see more like 2,000 per year, the cost savings is $1,200 per week or $62,400 per year. And what we do with that funding is reimbursed in our dental providers. In other words, I can hire two dental therapists for the cost of one dentist and they can provide 50 of the most commonly needed restorative procedures in our clinic.

Kevin: First of all, I want to thank The Kellogg Foundation for putting their emphasis and financial backing to this problem. It has to be addressed, there’s no reason it can’t be addressed, and with experts like we have on today’s panel and the conversation starts to get discussed, action steps can be made.

I want to thank our three speakers and guests today. Dr. Mary Willard, Director of Dental Health Aid Therapist Educational Program at the Alaska Native Tribal Health Consortium. Ms. Sarah Wovcha is the Executive Director of Children’s Dental Services in Minnesota. And Dr. Terry Batliner is a member of the Cherokee Nation and currently working on faculty at the University of Colorado and is also the owner of Sage Dental Care with three private practices also in Colorado. Your expert opinions, in my opinion, are so important.

I can tell our audience, I know that this is a difficult subject for many, but quite honestly it’s pretty straightforward. Let’s get together as a profession. Let’s recognize the seriousness of the problem. Let’s put our heads and minds together and try to eliminate our selfish own wants and needs and see if we can tackle this from a political standpoint and educational standpoint. As I see it, it’s a nutritional issue, a motivational issue, an educational issue and with experts like on today’s panel, there’s no reason we can’t improve the current situation.

I want to say thank you to all three of you very, very much for your expertise and time. I would like to follow up. I can tell from responses that there will be many other conversations and other points of view. But you’ve been listening to Ascent Radio.

My name is Dr. Kevin Coughlin. Please, for this podcast and other information, turn to Ascent-Dental-Solutions, with a focus on knowledge, consultation, training and development.

In closing, special thanks to Mr. Doug Foresta and his company, Stand Out and Be Heard, for sponsoring this expert podcast and the production of those podcast. And I also want to give special thanks to VOCO and their financial support and their excellent products and services to the dental community.

Thank you all for listening. This is Dr. Kevin Coughlin and I look forward to speaking to you soon.  

Hello and welcome to Ascent Dental Radio. A program dedicated to the balance between the clinical aspect of healthcare and the business of healthcare. And now here is your host, Dr. Kevin Coughlin.

Welcome. Today’s podcast is brought to you by Ascent-Dental-Solutions. You’re listening to Ascent Radio and my name is Dr. Kevin Coughlin.

As always, I’d like to give special thanks to Mr. Doug Foresta and his company, Stand Out and Be Heard. Without his expertise in podcasting none of this information would be available. I also would like to thank VOCO. VOCO Dental Supplies provide some of the topnotch, best supplies in the dental business.

VOCO has been sponsoring Ascent-Dental-Solutions and my thanks go out to their company and their support in providing information to the dental community.

Today’s topic is from dental school to a dental practice. Twenty questions to get your career going in the right direction. My name is Dr. Kevin Coughlin. I have 14 practices here in Massachusetts with 150 plus employees, 23 dental associates and I’ve been practicing general dentistry for the last 34 years, and still practice to this day, and actually was practicing a few hours ago.

So the trials and tribulations that I deal with on a day to day basis are coming from personal experience.

But today’s topic, if you’re interested in hearing more, you can go to www.ascent-dental-solutions.com, sign up for our program and we have a free webinar offered June 26th at 6:00 pm EST. That webinar will go into greater detail about the trials and tribulations of being a recent grad and looking for that first job. Also, this ties in for the senior dentist, knowing what that new graduate is looking for so that both parties end up with the best results.

Let’s get started. First, as a new graduate, you must actually have some kind of background and understanding of where you’d like to go. Your options are generally as follows: you can start in a solo practice on your own, you can join a solo or group private practice, you can consider your corporate options such as a DSO or Dental Support Organization or MSO, Managed Support Organization.

The difference between the two is, in general terms, the Dental Support Organization is backed by dentists, owned by dentists, controlled by dentists. The MSO or Managed Support Organization is generally backed by venture capitalists equity groups.

And although the probably would like to think that the dentist is in control, in general, like most business, the people who put up the money and are paying the bills are generally in control. That would be up for further discussion in a follow up podcast.

But to stay on topic today, what I really would like the new graduate to look at and to consider is to determine what course is best for you. Think about dating. Think about marriage. If you decide that you’d like to have a different partner every six to eight weeks, if you like to play the field, if you’re not really interested in children or settling down, then probably a marriage would not be the best opportunity for you.

In business, ask yourself the following questions;

1. Would you prefer to handpick your employees, yes or no?
2. Are you good at networking, meeting new people and marketing your services, yes or no?
3. Do you have a clear and unique vision for the type of dental practice that you want to create, run and manage, yes or no?
4. Are you comfortable developing policies and procedures for a wide variety of topics, not just clinically but business-wise for your practice?
5. Are you passionate about creating a professional environment and surroundings?
6. Do you have an idea or goal or vision of what you’d like to see your practice and how you’d like to treat your patients and provide care and services?
7. Are you willing to invest the time it takes to get started? In general terms, in my 34 years of practicing dentistry, I have found that it takes between six and 18 months before your business starts running a profit. And for the new graduate, you must understand the trials and tribulations of not being on a guaranteed income. The risks that not being on a guaranteed income create for you and your family.
8. Are you comfortable being financially frugal for at least some period of time? Because in those growing years, there’s tremendous risk and there’s tremendous trials and tribulations until your processes and procedures are in place and your patient flow is in order.
9. Are you interested in handpicking your equipment and your employees?
10. Do you have a distinct idea of what you want in an employee and in an equipment and supplies?
11. Do you enjoy and have the self-knowledge and acumen to make business decisions, whether that’s deciding whether to lease or purchase, whether it’s deciding which insurance plans or third party players you’d like to join or not join?
12. Are you flexible with the location and the community in which you’re willing to work?
13. Is having a commitment and a tie to the community important to you?

If the answers to those questions are yes, then then more than likely, your personality profile will fit ownership; buying an existing practice, running it and controlling it yourself. If the answers to these questions are no, then in most cases, you would probably be better off considering some kind of corporate entity or group practice where you’re more or less an employee.

And by all means, there’s nothing derogatory with being an employee. Some people actually are much more happy just focusing on their clinical care and treatment and letting the trials and tribulations of running a small or medium or large size business to people who may have better business training, better knowledge and expertise in these areas . So please, don’t take this podcast out of context.

My personal opinion is based on your personality, your drive, your fortitude and what you’re looking for in the ten to 20 questions that I just posed, will probably help you decide whether you really like to be in business for yourself or you’d rather have someone else be in charge of those types of decisions.

I cannot emphasize how critically important coming to that conclusion and answer within yourself will drive you in the correct direction and make your business and personal life so much more comfortable and in my opinion, so much less stressful.

So think about those questions and consider the podcast on June 26th at 6:00 pm for additional information when I’ll go into greater details with Mr. Steve Parker, the CEO of Excellence in Dentistry and also the producer with Woody Oakes, Dr. Woody Oakes of The Profitable Dentist Magazine. I cannot emphasize the importance, again, of asking these questions, reflecting on them and having them determine the direction that’s best suited for you, your family and your personality.

Once you get through with the direction, you must then consider, what are the options for developing and purchasing a solo practice? In this short 20 minute podcast, I could generally tell you these are some of the things that you should consider. You should be able to obtain the last three year tax returns from the office that you’re interested in purchasing.

For this hypothetical example, assume that the average is $1 million. I will then tell you in general terms, somewhere between 35 and 60 percent of that fee would be the purchase price, excluding any real estate. That would be generally 80 to 65 percent would be associated with goodwill and the balance would be accounts receivable, supplies and inventory.

Just as a general rule, anywhere between 35 and 65 percent of those average three years will be a ballpark figure of what I think will be a relatively fair acquisition for the practice. The reason there’s such a broad range between 35 and 65 percent is the practice that you’re considering, is the existing owner going to stay with the practice or are they going to leave the practice immediately, or in some timeframe in the next 12 to 24 months?

The longer the existing owner is willing to stay with you, in my personal opinion, the higher the percentage and the more valuable the practice would be for you. Because more likely than not, the goodwill that you’re paying for you’ll actually get value for. More than likely, the staff will stay with you. More than likely the majority of patients will stay with you.

When you make this acquisition into a solo practice and the existing owner plans on leaving the practice relatively soon, then my personal experience over three decades is that approximately 30 to 40 percent of the patient base will be lost and approximately 50 percent of the staff will leave within 12 months. And that’s because they haven’t had a chance to adjust to your philosophies, your process and procedures.

Taking a look at the next option, which is joining a corporate entity, I think you have to understand some of the basic business principles. When you’re joining a corporate, whether it be a DSO or MSO, understand one thing; it is a business and they have investors and they must provide a return on their investment to those investors. If they don’t, then that equity group has made a bad decision and in my opinion, very seldom do they like making a bad decision.

Knowing that, the first thing you have to understand is in most cases you’ll be compensated on either a production or collection basis. Right now throughout the United States, anywhere between 25 and 35 percent of net collected money is generally considered a realistic compensation package. In many cases, these corporate entities will want you to pay between 25 to 100 percent of your laboratory bill.

In most cases, they’ll be willing to offer you some kind of continuing education package, some type of 401k profit plan. In most cases, they won’t contribute to their profit plan, but at least it would be managed and maintained and be a vehicle for you to put in pre-tax dollars. In many cases, they will pay for your malpractice insurance.

And for the new graduates, generally you can expect the malpractice cost annually of anywhere from $1,800 a year to about $5,500 dollars a year, depending on the procedures, your background and training that you’re implementing.

I cannot emphasize enough that from my own personal bias, owning something, in most cases, offers the greatest likelihood of financial success. Obviously, there are exceptions all over the place, but my personal opinion is for the best financial success I would guide the new graduate to consider ownership.

Remember, for those novices, when you don’t own the majority or 100 percent, many times the decision processes will be made by other people. So you may share in the profit, you may have ownership, but the decision process may be out of your hands because the majority or principal ownership is owned by other entities, other individuals. And that may or may not be something for you to consider.

In the end, corporations that offer MSOs and DSOs, they offer you a work-life balance. As I like to say, they paint a tremendous picture of how you can go home at night with less worries and stress, focus in on what you’ve learned over the last four to six years of dental education and provide excellent high level care and service to your patients, which in my personal opinion as a healthcare provider, should be the number one goal.

What you give up is control. What you give up is the autonomy to take your business, your patients and your practice in the direction that you think is best.

That corporation may in the back of their mind want the best, but they have a different strategy and different obligations. Their obligation is to minimize expenses, maximize profit. So in a specific period of time, usually between three and seven years, they’ll plan on selling that asset and move on to another category of assets or perhaps in an entirely different business direction. And the new owners may have similar or different wants and needs. So you must understand that you may have to be flexible because what you like now, three to seven years down the road may be entirely different. It may be better, but it could also be worse.

When you’re in that solo practice or group practice that’s owned and provided by dentists, many times you’re on like minds. You have a similar idea, you’re more focused on quality control, you’re more focused on long term relations and you’re more focused on building long term relationships and business processes and procedures that will prove over the test of time. You’re in it for the long gain.

I always say that these are difficult decisions. They need a process and a procedure. You need to really think long and hard about what makes you tick. And once you understand that, you’ll make the correct decision, or most likely the correct decision, to move in the direction of solo and group practices controlled and owned by dentists or corporate dentistry that are generally managed and run by VCs, business men and women that may or may not have a similar strategy that meets your wants and needs.

Like everything in life, there is no 100 percent guarantee in any route. Each of us in our dental profession have strong beliefs and desires about what corporate dentistry is and is not, and what private practice is and is not. And after 34 years, my personal opinion, again, is your personality, what makes you tick will determine whether one direction or the other direction is best for you.

I’m planning in going into greater detail on the upcoming webinar this June 26th at approximately 6:00 pm at night. Please go to Ascent-Dental-Solutions, in that website to sign up. I look forward to going into greater detail with Mr. Steve Parker and I hope to be able to answer questions online.

Please feel free to submit them to Ascent-Dental-Solutions so that I can, perhaps, address some of these questions ahead of time and be prepared for them.

You’ve been listening to Ascent Radio. My name is Dr. Kevin Coughlin. And again, special thanks to Mr. Doug Foresta and his company, Stand Out and Be Heard.

Hello and welcome to Ascent Dental Radio. A program dedicated to the balance between the clinical aspect of health care and the business of health care. And now here is your host, Dr. Kevin Coughlin.

Kevin: Good afternoon. This is Ascent Dental Solutions. You’re listening to Ascent Radio. My name is Dr. Kevin Coughlin and I want to thank Doug Foresta. Without his expertise and his business, Stand Out and Be Heard, we would not be able to have this podcast on a weekly basis. Doug, thank you so much for your expertise and your knowledge in podcasting.

I also want to give special thanks to VOCO. VOCO has also been a sponsor of Ascent Dental Solutions. VOCO is a German company with headquarters in South Carolina and they provide over 210 different dental products to the dental market. These products are excellent. They can compete with any brand and their care and service to my organization has been exceptional. Thank you, VOCO, for your promotion.

Today, our guest is Mr. Chris Collins. Chris is a web designer, a graphic designer, a creative freelancer. He works with entrepreneurs, small businesses around the world to help their businesses grow and start their dream products.

In full disclosure, the logo for Ascent-Dental-Solutions, which focuses on knowledge, consultation, development and training, was produced and done by Chris. Chris, nothing but positive reviews for my logo. I want to thank you very much.

How can you help the healthcare profession, but dentists in particular, improve their branding? What are your suggestions and recommendations? And is branding even important for a solo practitioner or a small group practice or large group practice?

Chris: Thank you for having me on and thank you for complimenting me about the logo. It was a lot of fun to make and I’m glad that you got good feedback. I think branding is of the utmost importance for all businesses, dentists and healthcare alike. We’re living in an age where folks can pick and choose a lot of different options and the world is at their fingertips on the internet. A quick Google search away they can find many different options, get in the car and go to many different practitioners, dentists, anything.

Having very strong branding, I think, is quite important because a lot of people make their decisions based on what they see online or what they see in print and sometime it just comes down to do I like the look of this business? You want to have it be consistent as well.

I see a lot of businesses thrown around different materials both online and in print and in person that don’t really give a cohesive and consistent look into what their business is all about. So I think that branding can really help with that and especially logos and flyers, advertisements, all those things.

Kevin: In your research, Chris, in your opinion, from the general public standpoint, what is probably most important in our listeners, or let’s just say our patients or clients? What are they looking for that, in you research, is most important to the physician or dentist in healthcare? What are their patients and clients really looking for?

Chris: I think it depends on the person who’s looking. I think there are a lot of different aspects to why someone would pick a certain business. So the way that you present yourself, both online and in print through marketing of any kind, is very important.

So you want to kind of cover all your bases and think about the type of audience that you have or the type of customer base you have. You want to look at the reviews you’re getting online, which are very important, and see what people are saying. You want to take a look at your competitors and see why maybe they’re getting more business than you are. And use marketing and use the internet and social media and design to your advantage.

Kevin: I’ll share with the listeners a story that just happened to me last week. I started business in 1983. For those listeners, we have 14 offices, about 150 employees here in western Massachusetts. I’ve been doing double trunk ads in the Yellow Pages back in the early 80’s, radio shows, TV, all kinds of different marketing. Recently, one of the individuals associated in our business thought it might be sought of comical to do a TV ad where the doctor is actually holding a carpenter drill and that drill is held in the hand like they’re drilling on a patient’s mouth.

The objective, in my opinion, was to lighten up the advertisement, to add some humor. The negative feedback from that, in my opinion, was astounding. In other words, I spent 34 years building a state of the art practice with the highest levels of efficacy, service and care, and in a 60 second pitch you sort of defeated almost all of that in such a short period of time.

I know that the intentions were positive, but the results, in my opinion, were less than positive. And certainly, the feedback that I’ve heard from individuals like, “Dr. Coughlin, what was the idea of having that old-fashioned drill? That scared me.”  Et cetera, et cetera.  

I learned firsthand how something unintentional can have very intentional consequences.  It could have happened to me, it could have happened to any of our listeners, but I would be very cautious on how you present your business and yourself and the points you made, also depends on the individual clients that you’re promoting.

My particular expertise is you generally have three categories of patients or clients. You have those gold card patients that have no insurance. They demand the highest level of care and service. They have the financial means to get that care and service. They can be extremely demanding and want only the best.

Then you have the other extreme that are many times under subsidized government plans. They generally pay for no care and no service. These are subsidized by taxpayers and generally their treatments are dictated by government agencies. In other words, they only pay for certain procedures and processes, not everything.

Then the vast majority falls somewhere in the middle. They’re looking for the highest level of care and service, but it has to be affordable for them or at least terms have to become available for that affordability so they can get the care and service they’re looking for. In your professional opinion, with those three basic marketplaces, do you see anything particular in a brand that works better in one area rather than another?

Chris: Yeah, I think it goes without saying that I’m learning something. Thank you for telling me a lot about this. I don’t know too much about dental industry, but that makes a lot of sense that those three exist and that you may want to look at them in a different light. I think that yeah, your branding can definitely differ.

If you have someone who has a lot of income to spend on this and is basically paying for things out of pocket, if I’m understanding that correctly, they want to know that the quality is there. And maybe the price isn’t as important, so they want to see all the options. They want to be impressed by what you have to offer.

Whereas other folks really want a kind of down to earth, very comforting like you come in, we are not going to cost an arm and a leg, we’ll take care of everything for you. Your insurance will be accepted. Everything is going to be easy and painless.  And they may not want to be scared away by the big ticket items that they may want but they just can’t afford.

I’m not sure if that answers your question, but branding can do a lot and marketing can do a lot to discourage folks from coming if they only are interested in one thing, say price, or it can encourage people if they’re interested in more. So you can’t ignore those aspects of marketing and let customers fall through your fingers or be scared away.

Kevin: Chris, take us through the process. For those listeners thinking about hiring you or just trying to gather additional information, what is the actual process where you educate the healthcare professional in how to create a brand, how to market that brand? What are the actual steps and the time that’s associated and potentially the cost of creating a brand that’s going to be successful in the short and long term?

Chris: It’s different for everyone and I think that’s an important part of my process which is every business and every person and every entrepreneur has a story. I really liked hearing your story about the failed TV ad, that was really interesting to me. So if I were meeting with you or any other business, I would want to hear your stories first and usually within a few minutes, I get a very clear idea of what the business is like and what the person is like and the kind of customers that they get, and more importantly, the kind of customers that they want.

It’s usually very clear quickly what their target demographic is and what their business is all about. It’s funny that in such a short time I can get that information.

People, when they start speaking about their passion, project or their business or whatever we’re working on, it becomes clear that they are interested in a particular demographic. There’s a particular vibe, I guess. And that’s one of my strengths, I think, is seeing right away the type of business and the direction that they want to go in.

From there we kind of know who they’re looking for as a customer and we can kind of drill down what has worked in the past and what could work. And a lot of times what they’re doing now they may know I want to attract this kind of customer to my business.

But everything that they’re doing in terms of branding or marketing isn’t really attracting that type of person. So we can kind of look at it and say, “Why don’t we start here? Why don’t we design a brand that speaks to those people?”

First we may start with the logo. Website is of great importance. Do we want to do advertising? Do we want to do social media? Are you thinking you’re going to be getting a lot of new customers from the internet? If so, we probably want to spend a lot of time thinking about SEO, which is Search Engine Optimization. So I do pretty much all of that for my clients.

They could start with just an idea and by the end of working with me we have a logo, we’ve got a website, we’ve got a whole plan going forward, we’ve got a store online. Whatever it is they want, I guess in your case it wouldn’t be a store, but we can do it all. It really starts with the vision that they have.

Kevin: Nationally, the United States, the average dentist has revenues depending on who you’re quoting and the data you’re looking at, of anywhere between $800,000 and $1.2 million. And as a general rule of thumb, the marketing budget for that is between two and four percent.

So basically speaking, if we took $1 million and we said five percent, you have roughly a $50,000 to $ 35,000 budget yearly. Are those dollars adequate to create the expertise that you have for, I hate to use the word average practitioner, but to give our listeners some down and dirty information so that they can help process the information and create the right processes and procedures that work best for them?

Chris: Yeah, I would say that’s adequate. I know that all businesses are different and I pride myself and I hope other people in my profession do too, on working with companies of different sizes. I really like working with small businesses as well as larger businesses and entrepreneurs.

Typically, to create a brand and a website and just to get it all started online, which is the biggest part of my business, usually costs less than $5,000 at least for a basic but beautiful website. That leaves quite a bit for, I would suggest, advertising.

I don’t know if you want to talk more about advertising, but advertising using Google is an amazing tool. You talked about your television ad, but nowadays you can target your ads; who is searching for a dentist within five miles of this particular location?

So you can really drill down and you’re only paying for it when people click on your ad and go right to your storefront or your website or you’re paying only when people call your business. So you’re really drilling down to potential customers. You’re drilling down to I’m paying for when people call, new customers call. And then you can work with your staff to make sure that hopefully they make the appointment and you get a new client or customer.

Kevin: I can tell you from my own 34 years of experience owning a small business and building a small business that there’s two things our listener should consider. One, getting them to call the office. How do you get them through that front door? But equally, if not just as important, if you screen, your profile, you evaluate the calls coming in, the single biggest question that we get day in and day out, is do you accept a dental insurance?

Since the vast majority throughout the United States has some kind of dental insurance, for the vast majority of dental practices, they would be marketing to an insurance based clientele.

And no matter how great the brand is, no matter how much the patients love you, at the end it many times comes down to dollar and cents for the vast majority of patients. And the question that we’ve been charting for years, and that single one question is, do you accept our plan?

For our listeners out there, please make sure you know the dental plans that you’re accepting and not accepting. Because you can have a hundred calls in a week, but if I’m correct — and I believe I am — that they want to know, is the procedure covered, do you accept my insurance, and the answer is no, then you may be paying for a click you may be marketing. And really I think for the vast majority of healthcare professionals, certainly in the field of dentistry, certainly your easiest clienteles to deal with, your most profitable clienteles are those that are fee for service.

You don’t need ancillary team members to process claims, call insurance companies, hunt down those finances, determine what’s approved and what’s not approved, what would be paid for, what’s not paid for. So those individuals that don’t have insurance, in my personal experience, those are the ideal, best clients for your practice to build the most profitable and successful business.

For all of us we probably have to meld these different groups of clients in there and I would caution you to make sure your front desk team members, your patient coordinating schedulers know exactly what plans are covered, what plans aren’t covered and what kind of dollars would be generated from the procedures that you’ve accepted in those plans. And if not, you many times find out you’re seeing plenty of patients but you’re losing money month after month because the plans that you’ve signed up for are no longer cost effective.

I’ll give you a quick example. The state pays $14 to provide inhalation sedation. And I’m saying to myself, if it’s costing me $100 to get my nitrous oxide tanks filled and I’m being reimbursed $14, you don’t have to be a mathematical wizard to find out that this is probably not a profitable procedure for you and your staff.

We’ve got a few minutes left and Chris, if people were trying to find you, if they wanted to get out there and give you a call or send you an email, what’s the best way to contact you?

Chris: I would say, just go right over to my website which is www.chriscollinscreative.com. My brand is Creative. I was going to mention, if we do have a minute, about what you just said. You can be very creative about getting in front of some of these problems that you had.

You said a lot of people are asking the question, do you accept my insurance? If I heard that from a client, I would say, this is maybe something you’re wasting a lot of time on answering that question, maybe saying no, maybe saying yes. So we should have on the website a very easy to spot place where that question can be answered right away for them.

In terms of the advertising, you’re right. You don’t want to be paying for a click from someone who may not end up being customer, so why not create advertisements online that cover those basics? I know when I’m searching for a practice I may say, who accepts in the western Mass area, my insurance. That may be my search online. And you can profit on that by creating an ad that targets people who are searching for just that.

So you could have a series of ads that are targeting folks who only accept the types of insurance that you accept. Or if you’re looking for people who don’t have any insurance because they’re the better customers, create ads that look for folks who don’t have insurance. So there’re a lot of ways to do that.

Like I said, my website is www.chriscollinscreative.com. So if you’d like to find creative ways to get more business, that’s pretty much what I do.

Kevin: Chris, it’s been a pleasure for you to take your busy schedule and speak to us on today’s podcast. Again, my personal thanks. The logo you developed and the assets that you’ve helped me with in developing a brand for Ascent-Dental-Solutions has been instrumental in providing success. Thank you so much. And again, for the listeners, it’s www.chriscollinscreative.com. Thank you Chris so much for your expertise.

And I want to thank Mr. Doug Foresta and his company Stand Out and Be Heard for the production of this podcast. Week after week he spends his expertise and time to put out the best product available.

You’ve been listening to Ascent Radio. My name is Dr. Kevin Coughlin and the knowledge, understanding, education and training of Ascent Dental Solutions is paramount.

And I also want to end by thanking VOCO for their expertise and their help in sponsoring this information to get out to the healthcare profession and businesses in general.

My name is Dr. Kevin Coughlin, thanks so much for listening and I look forward to speaking to you very soon.

Hello and welcome to Ascent Dental Radio. A program dedicated to the balance between the clinical aspect of healthcare and the business of healthcare. And now here is your host, Dr. Kevin Coughlin.

Kevin: Welcome to Ascent Radio. My name is Dr. Kevin Coughlin. You’re listening to Ascent-Dental-Solutions, where the focus is on knowledge, training, education and development.

This podcast is brought to you by VOCO Dental Supply, one of the largest and best dental materials company in the United States. Originally from Germany, but have headquarters in South Carolina, and I want to thank them for sponsoring this podcast. I also want to thank Mr. Doug Foresta and his podcast company, Stand Out and Be Heard. Without his expertise and mentoring, this podcast could not be possible. What he’s done for my professional business and my consulting business I cannot say enough about.

With no further ado, I have some questions today about a topic that seems to be getting more and more attention and more interest in the dental community. And that’s corporate dentistry, in particular, MSOs and DSOs. Why don’t we start with the first question?

Doug: Sure. Thank you, Kevin. Great to be here with you. My first question for you is — there was an article recently about how to know if it’s time to create a second practice. If you’re a solo practitioner, when is it time or what are some considerations? So my first question for you is, if I’m a solo practitioner, maybe I’ve been in business for five years or so, what are some of the considerations that I should think about when thinking about the idea of potentially starting a second practice?

Kevin: Since this podcast is only roughly 20 minutes, I will do my best to stimulate your interest. But keep in mind that I have been practicing and still practice dentistry every single day, Monday through Friday. I have 14 offices and I have gone through the trials and tribulations and these questions in my own mind and still do to this day. In summary, my first recommendation would be to think long and hard about what your end gain is.

Are you building additional practices to sell to a DSO or MSO to get the maximum value down the road? Are you growing because your facility is just over utilized and you’re no longer efficient and effective and you’ve decided that you’ve been so successful at one practice you want to continue and grow your business with another location?

Those two general questions would drive my answer when I’m doing consulting to dentists all over the country. And that is, what is it you’re trying to obtain? To cut to the chase, my personal opinion dealing with hundreds, if not, thousands of dentists over the last 35 years is that most are interested, whether they know it or not at the beginning, to get the best return and the biggest return on their investment.

Meaning that if one practice is successful and the second practice is just as successful, the investment and the return on your investment will be significantly better than just selling one solo practice. I’m going to assume that if you’re not aware of it you ultimately will come to the conclusion that the more successful practices, and the better the processes and procedures, the more valuable this entity is to a potential purchaser.

When we talk about potential purchasers, depending on the number of practices you accumulate and run successfully, your value will go up, but the number of individuals interested in that practice will go down. For the average dentist to be able to afford and purchase three, four, five, ten or fifteen practices, I believe there are few and far between potential purchasers.

So in most cases, you will ultimately be leaning towards a DSO or Dental Service Organization, which by definition are run and owned by dentists, or an MSO, Managed Service Organizations. Which no matter what we talk about, not matter what we think, in the real world, they’re run and operated by equity partners, venture capital groups that hold the money, that pull strings and ultimately the decisions for better or worse.

With that being said, my learning curve taught me that you should never expand into another location, unless your first location has excellent processes and procedures. That means infrastructure is in place, you have adequate staff at your front desk, you have adequate chair side assistance, you have adequate dental hygienists and you have adequate, and let me emphasize this, hardware and software controls. The older you are, the greater the likelihood that your return on investment could be much less.

I look at this very much like anything that you do in the market. You can afford to lose almost everything in your 20s and 30s and you still have plenty of time to rebound and be very successful financially, in your 60s and 70s. But when you start this type of aggressive expansion, the money and time effort when you do it in your mid-career to late career, sometimes may prove out to not give you the best return because of the significant amount of money you’re going to have to invest and the significant amount of time.

So for those listening to this podcast in their early 50s or late 50s, make sure you fully understand the financial and the emotional time commitment of opening up additional practices and what you can expect for your return on investment. Unless you’re an incredible superstar and you can get that practice up and running, profitable, with an EBITA of at least $300,000 to $400,000 within 12 to 18 months, you may find that your return on investment may not benefit when you put in the amount of risk and effort.

Doug: And that’s the other piece I was going to ask you. Have you seen dentists who have gone for it, so to say, and it hasn’t worked. What do you do if you try it and either financially it’s not doing the way you thought it would or it’s just not for you, like you decide this is not me, what then? I guess would be the question.

Kevin: You deconstruct. I would say, take the practice that’s the weakest and unload it as quickly as possible to an associate or a dental broker. You may lose a little bit of money in the process, but my opinion is there’s no reason beating a dead horse. Bad is bad and usually, the longer it takes you to make a decision, the more costly it is and the worse it is in the long run. So I would say, cut your losses as soon as possible and unload that practice as quickly as possible and focus in on your initial practice and continue to build it and consider it a learning experience.

Obviously, with proper mentoring and coaching from someone like myself or other experts in the area, what ideally you want to do is avoid the mistakes that people like me have made so that you’re the most effective and most profitable with the least amount of stress. And it’s like anything, reduce your learning curve will increase your chances of success not only emotionally but financially.

Doug: One of the things I was going to ask you as well, Dr. Coughlin, is that is this something that is even talked about at this point in dental school? That’s what I think is so important about what you’re doing. Is this something that’s even discussed, that I would learn if I went to dental school?  

Kevin: I know starting in 2006 I started lecturing at Tufts School of Dental Medicine in Boston Massachusetts. At that time, I was not aware of any of the schools in the Unites States really addressing the business component of medicine and dentistry. I think with the average school debt of about $267,000, the time commitment, the loss or opportunity cost of spending four to six additional years of training and education and with a high debt structure, it is absolutely imperative that these young practitioners get basic business knowledge either from people like myself or I’m happy to say I see that the schools  in order to keep their accreditation are now mandated to offer between 18 and 22 hours of practice management before these students graduate from dental school. So more and more I see this drive to educate and inform these young practitioners so that they can minimize their errors and maximize their potential.

Doug: Thank you, Dr. Coughlin. I really appreciate you taking the time to share your words of wisdom and perspective from someone who, as you said, owns and operates 14 dental practices.

Kevin: Right, and they’re certainly practitioners out there that have more practices than me and have been just as successful or more successful. I’m happy to share my trials and tribulations and I’m pleased to present this on Ascent Radio and I want to thank VOCO Supply Company for sponsoring this podcast and our previous podcasts. And special thanks to Mr. Doug Foresta and his podcast company, Stand Out and Be Heard. Without his expertise and production acumen, we would not be able to present this on a weekly basis.

Thank you so much for listening. This is Dr. Kevin Coughlin. You’ve been listening to Ascent-Dental-Solutions, with a focus on training, education, development and knowledge. Thanks for listening and I look forward to talking to you soon.