The Dentist's Network #79

Louis Malcmacher
DDS MAGD
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Do Dentists Have Low Self Esteem?

The answer is yes, dentists do have low self-esteem. I will say it unequivocally and I will tell you that it is time that we do something about it. In addition to my general and cosmetic dental practice, my other full-time job is presenting, teaching and educating dental professionals. I speak to thousands of dentists every single year so I feel that I have a fairly unique insight into the mindset of general dentists. Here are a few of the reasons that I think dentists have a low professional self-esteem.

First of all, we need to make dental continuing education more engaging, more enlightening, and certainly more interesting and fun. I gave a lecture a few months ago at a fantastic dental meeting, The New Mexico Dental Meeting in Albuquerque. I was walking from the hotel, which was a couple of blocks from the convention center, with a group of dentists, hygienists, assistants, and office managers. They didn’t know who I was, and I certainly didn’t know who they were either. As we were walking into the convention center and being joined by a few other dental professionals, I overheard one hygienist say to another, “I hate going to these dental continuing education classes, they are so boring. I would really rather be working.” To me that was certainly a challenge and I used that in my opening remarks in that meeting, which sparked a good bit of laughter. Why do some dental lecturers insist on talking down to dentists, maligning other schools of thought, and have a brusque attitude with their audiences?

Thankfully, we are blessed to have many motivating and engaging speakers who really help raise the dental industry’s self-esteem. People like Sally McKenzie, Dr. Harold Crossley, Dr. Joe Blaes, Dr. Lorne Lavine, Dr. Michael Silverman, Dr. Tony Feck, and others who know that people learn better when they are engaged and entertained. Whenever I personally give or take a continuing education class, I want to walk out of that meeting room not only educated but also inspired about what I can provide to my patients.

Another reason that dentists have low self-esteem is because we really don’t think of ourselves as “real doctors.” It’s time to take a good look in the mirror and realize what we know and how that knowledge can benefit our patients, especially when we work in conjunction with other healthcare professionals. I will point to two areas specifically – one is the oral-systemic connection and the other is the total facial esthetics connection. I have been heavily involved in both of these areas for the past few years. Many dentists do not take the time to connect with physicians when the patient has systemic diseases that can be improved with proper oral care. I have had many physicians and nurses thank our office for the ability to work together with them so that the patient has better health outcomes. The area of total facial esthetics is an area where dentists really shine in comparison to other healthcare providers. Now that I have been heavily involved in providing and teaching Botox and dermal filler therapy (www.commonsensedentistry.com) , I work with many esthetic dermatologists, plastic surgeons, and physicians who treat dentists as peers. Indeed, they are surprised when they learn dentists have only recently been able to provide Botox and dermal fillers in many states. There is much that dentists can teach esthetic physicians in terms of smile lines, lip and cheek support, lip lines, esthetic dentistry and how esthetic dentistry fits into the facial esthetic world. Unfortunately, it’s dentists who try to prevent us from interacting in these areas.

It is high time to look ourselves in the mirror and finally understand that we are not only teeth mechanics, but have a lot to offer to the overall health and well-being of our patients, as well as giving them a great looking and healthy smile. Let’s start working with other healthcare providers, who often treat us more professionally than we sometimes treat each other. We are highly trained healthcare, clinical and esthetic professionals who specialize in the oral and maxillofacial areas. Let’s take ourselves more seriously as a profession.

Dr. Louis Malcmacher is a practicing general dentist in Bay Village, Ohio, an internationally known lecturer, dental consultant and author, and consultant to the Council on Dental Practice of the ADA. Interested in knowing more about how to truly enjoy dentistry? Click here.

Interested in having Dr. Malcmacher speak to your dental society or study club? Click here. To reach Dr. Malcmacher, email him at DrMalcmacher@thedentistsnetwork.net or call 1.800.952.0521.

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Dr. Lorne Lavine
Dental Technology Consultants
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Digital X-Ray Revisited, Part I

The look and feel of the modern dental practice has changed dramatically over the past 10 years. Systems that were once paper-based have now moved into the digital realm. There’s no doubt that technology has been the driving force in many of the dental advances over the past few years. This is as true in other fields as it has been in dentistry. In the early 1990’s, intraoral cameras were all the rage. In the late 90’s, it was digital cameras. And, at present, no other topic seems to generate greater interest than digital radiography. While entire books can be written on the subject, the goal for this article is to focus on how digital radiography can improve the profitability of the practice, particularly by improving case acceptance. In part II, which will be published in a few weeks, we'll take a closer look at the infrastructure this is required as this is often overlooked by many practices.

Having worked with hundreds of offices who have installed digital radiography, the biggest hurdle to adopting this technology is financial. While the initial costs are high, there is little doubt that using digital radiography can definitely help the bottom line of the practice by increasing patients’ willingness to come to the practice and accept treatment. There are a number of key areas where digital radiography makes sense:

1. There is no doubt that in order to increase case acceptance, we have to improve our ability to diagnose disease. The vast majority of dental practices find digital radiography to be superior to film. In a recent survey in DentalTown magazine, over 73% of the respondents claimed that they found digital radiography to be more diagnostic than film. There are a few reasons for this. First, there’s a big difference between seeing a life size image which is around 1” vs. an image magnified to fill up a typical 17” or 19” screen. Secondly, and just as importantly, all digital radiography software gives us incredible tools to improve diagnostics. There are a few programs that really simplify this process. For example, XDR, a smaller company from the Los Angeles area, offers a “caries” icon and a “perio” icon. One click of the icons will apply numerous filters and enhancements to bring out the diagnostic features of the image with minimal muss and fuss.

2. A practice that is efficient and saves time will be very attractive to your patient base, many who are busy and would prefer to minimize the time spent in the office. The time savings with digital radiography are quite significant. However, it’s important to understand that the time savings are limited to the hard sensors. Phosphor plate systems, while an excellent option for many offices, do not provide any time savings over traditional film. Many offices can start and finish a full mouth series of radiographs in well under 10 minutes, allowing patients to get in and out of the office quicker.

3. Another key feature of digital radiography is the fact that you can reduce the exposure time of the radiographs. This can be a big selling point for current and future patients. One thing to be cautious of is that many vendors still claim unrealistic amounts of exposure reduction. When digital radiography was first introduced, film was much slower and their claims of 80-90% reduction in exposure were accurate. However, over the past 15 years the speed of film has greatly increased, and many offices are now using E speed film. While offices using digital radiography should still expect a reduction, it’s closer to 30-50% over film.

4. Probably the biggest selling point of digital radiography for case acceptance is the concept of co-diagnosis. In the past, patients had to rely on their trust of the practice and the dentist to proceed with dental treatment. In many cases, their conditions were not apparent to them, they did not have any associated pain, and patients often were unaware of their dental problems. While we often tried to show patients the x-rays on a viewbox, this is really not ideal for most people as they have trouble seeing the problems. Digital radiography changes all of that. Now, dental problems that show up in a radiograph can be viewed on a 17” or 19” screen, and the patients, for the first time, can see exactly what we as dental professionals can see. Once they see and understand their condition, they will be far more accepting of our treatment plans, as there will be no doubt in their mind about the status of their condition.

Lorne Lavine, DMD is the Founder and President of Dental Technology Consultants. Dr. Lavine holds two prestigious certifications, the A+ Certified Technician designation and the Network+ Certified Professional. These designations demonstrate proficiency in computer repair, operating systems, network design and installation. Dental Technology Consultants provides dentists a full range of services relating to the implementation of technology.

Interested in having Dr. Lavine speak to your dental society or study club? Click here. Dr. Lavine can be reached at drlavine@thedentistsnetwork.net.

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Bruce Bryen, CPA.
Managing Partner
The Snyder Group, LLC
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Evaluating Dental Practices: The Purpose of Ownership Agreements

A common goal in the financial success of a dentist is the evolution from dental school graduate to associate to owner. As an owner, the growth of the practice and professional achievements are areas to feel good about. When the practice grows, there comes a time when a partner may be added because of the saturation level of the practice and its opportunity for expansion. This stage in the dentist’s career is a turning point that will substantially improve his or her economic position or will create a set-back due to lack of attention to detail in arranging those agreements needed to protect the dentist against potential problems with a partner.

What steps should be taken to prepare the agreement?

Before a partnership begins, a necessary step is to have an effective, executed contract that lists the areas that have been discussed by the owner and the potential partner. The agreement should encompass points such as deferred and non-deferred compensation, the price of the acquisition and the terms of payment, restrictive covenants and other salient concepts regarding the ownership arrangement. It is important that advisors with expertise in the representation of dentists be retained to expedite the process. For example, the compensation package should account for current salary, retirement and fringe benefits. An advisor without experience with dentists may be unfamiliar with compensation based on a percentage of collected production. Earnings based on hours worked or an ownership formula will probably not be a good idea as time passes. A good producer may work fewer hours and create more income for the practice because of higher end cases. Earnings based on an ownership percentage do not reward someone for production. Another example for someone experienced in providing financial advice to a dentist concerns a purchase price for a practice and the terms of the acquisition. Will the payment be based on a pretax or after tax approach? Does the advisor understand restrictive covenants? Is there a provision in the agreement to buy out the restriction for an agreed upon price so that the partnership can terminate without the need for litigation?

The need for a fully executed agreement

When preparing the agreement, it is important to remember that when everyone gets along on a day to day basis, a contract is probably not that important. When there is a disagreement about a decision, the need for a fully executed well thought out document increases; and this is when the need for the agreement is essential. This is the time that the parties will be glad they hired an advisor with expertise in working with dentists and not someone with a strong background working with manufacturers or other professional fields not related to the unique qualities that dentists possess. A properly prepared agreement can save tens of thousands of dollars in legal and expert witness fees in the event of a lawsuit.

Retain the right advisors

Get referrals from colleagues who have had experience and success with advisors who have assisted them and who know the specialists. Accountants with few dentists as clients, as an example, may not have the expertise in your field. Get their resumes. Find out if they have published articles regarding your concerns. Find out how many dental practices they have evaluated. Have they assisted in the design of ownership agreements? A CPA with experience assisting dentists is an excellent source to head the team of advisors to help in preparing the ownership agreement that will ensure a safe environment in the event of a problem. That CPA will know the correct attorney who can prepare the agreement and will have a large degree of input regarding the business aspects of the ownership agreement. The termination of the partnership and continuation of the practice without interruption is the key to success in the preparation of the agreement.

The end is the beginning

Preparing the ownership agreement based upon the termination of the practice and working backwards towards the successful operation of the practice will provide the best method for the draft of the contract. What will occur if the partners do not get along and wish to discontinue the partnership? If the agreement encompasses the terms of dissolution so that the practice can continue and patients have little interruption in service, your advisors have accomplished the goal of a successful ownership agreement.

Bruce Bryen, CPA has successfully assisted dentists with their personal and financial matters for more than thirty years. As a partner in The Snyder Group, he delivers creative and prudent financial strategies to help dentists build and protect wealth at every stage of their careers. His extensive expertise includes financing, debt restructuring, retirement planning and tax advising to help dentists keep more of what they earn. Bruce is also experienced in providing litigation support services and has testified on numerous occasions as an expert witness.

If you would like additional help or are interested in having Bruce Bryen speak to your dental society or study club, he can be reached at bruce@thedentistsnetwork.net or at 1-800-988-5674.

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