The Dentist's Network #81

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

In my last article, we discussed the advantages of digital x-ray and looked at how to develop a positive return on investment, specifically focusing on improved diagnostics, efficiency, reduced exposure times, and co-diagnosis. While many dentists will spend a lot of time evaluating the pros and cons of sensors vs. phosphor plates and resolution of various systems, many offices still fail to realize the importance of improving their infrastructure to be able to handle digital radiography. A good digital system won’t do you much good if you’re struggling to make it work on outdated hardware and networks. Here are some key areas that should be addressed while you are also evaluating the digital x-ray systems:

1. Computer Server
The server is the lifeblood of any network. Many dentists fail to understand that the storage needs for digital x-rays are exponentially higher for images than if you just have practice management software data. The server must have enough memory to allow the server to multitask, and it should have fast hard drives to push the data out to the workstations quickly, an operating system that allows for control over the entire network, and a replacement part policy that delivers new parts in hours, not days. I currently recommend a Dell T300 server with RAID 1 (mirrored) 500 GB hard drives, 4 GB of RAM, Windows Server 2003, and a 4-hour contract. One thing to be wary of are new operating systems. For example, while Windows Server 2008 has been out for a year, many dental applications still do not work properly with it. Check with your software and hardware vendors before you purchase new systems for compatibility issues.

2. Network
Make sure that besides the server, you have proper network infrastructure throughout the office. Digital images are quite a bit larger than practice management data and you’ll need to be running at a Gigabit (1000 MB) per second speed. Make sure all network cards are 10/100/1000 network cards, use a switch (a smarter version of a hub) that can handle the faster speed, and use either Cat5e or Cat6 cabling. Cat 6 cabling is recommended for new offices since it will be able to handle a faster speed once that becomes the industry standard.

3. Computers in the ops
These computers typically need to be faster than front desk computers. One area to focus on is the video card. Cheaper computers often ship with the video chip fused on to the motherboard; you want to avoid these as they won’t be able to adequately handle large video files like you get with digital x-ray. Instead, get a computer with a discrete, or separate, video card. It’s becoming increasingly difficult to find computers preloaded with Windows XP, especially since Windows 7 will be released on October 22, 2009. However, XP is still far more stable than Vista and would be my best recommendation. As with the server, do not use Windows 7 in your office until the dental companies’ products have been verified to work with this new operating system.

4. Monitors
I consider this to be one of the most important decisions to be made when it comes to digital x-rays, and often the most overlooked. I see many dentists not even blink when spending $15,000-$20,000 on digital x-rays, yet they try to save $100 on a cheap monitor. The key statistic to evaluate is the contrast ratio - the difference between the whitest white and the blackest black. Ideally, look for a monitor that has a contrast ratio of at least 800:1. I personally don’t see much difference between monitors that are 800:1 and, say, 1500:1, but some people claim they can diagnose better with these higher contrast ratio monitors.

5. Data Backup
We’ve talked about this in previous articles, but once you make the decision to go digital with your x-rays, it is critical to have a good backup protocol and business continuity system. If your server goes down and you don’t have this, not only will you not be able to access patient information, you won’t even be able to take x-rays which can be devastating for a practice. I recommend a system like the DataProtect system we offer, which combines an emergency server in the office with an automated online backup.

Digital x-rays are a great option, but dentists need to make sure they take the time, and spend the money if necessary, to ensure a smooth transition by having proper hardware infrastructure.

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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Retirement Plan Discrimination Tests

Many dentists do not want to install a qualified retirement plan in their dental practice because of the contribution level of the employees compared to their own contribution level. The cost of the employees scares them into thinking that they cannot afford to have a retirement plan of any meaningful amount for their dental practice. The dentists read about qualified retirement plans and listen to their colleagues speak about the plans that they have and decide not to initiate a retirement plan for their own practice, but this is a mistake.

Can a retirement plan benefit the dentist without costing too much for employees?

The answer to this question is yes. The dentist and the key people that the dentist wants to have as participants under the plan document can be allocated as being eligible without having all of the employees count as participants with the corresponding contribution allocated to them. This will save an enormous amount of money, while at the same time allowing the dentist to contribute and save for his or her own retirement. The type of qualified retirement plan is the key to achieving the ability to exclude and not discriminate against employees, and to receive the approval from the Internal Revenue Service for a positive determination letter that the retirement plan has qualified for approval.

What types of allowable discrimination can be achieved?

This is a very complex question that does not have a simple answer. There are tests that must be performed to determine whether a plan document will allow the type of discrimination that a dentist will probably want in order to enable the contribution level to remain at an affordable amount. One test involves the number of people employed by the practice and the number of participants who would be eligible based on the number of employees working in the dental practice. Another type of test involves the job description of the employees. How many hygienists, dental assistants, receptionists, etc., are there in the employ of the dental practice? It is possible, as an example, to exclude hygienists under certain conditions. Other than dentists, this job classification is probably the highest paid of all the employees, so the potential exclusion of hygienists could be a key factor in the ability to afford a retirement plan. The age of the employees is another example of how the design of the plan could be prepared to keep costs at a low level.

Can discrimination be legal?

In this instance, it can be. Remember that the proposed qualified retirement plan design is submitted to the Internal Revenue Service for approval. When a determination letter arrives from the Internal Revenue that states that the design has been accepted by them, that means that the design has been approved and as long as all transactions and allocations take place according to the document, you can have legal retirement plan discrimination.

What happens if you can’t discriminate within the plan document?

There are still opportunities to allow a lower cost for contributions than originally thought. The concept of two plans, whereby one may be for the key employees and the other for the employees that are not considered as vital to the practice, can be designed and accepted by the Internal Revenue Service. This type of arrangement still involves a degree of discrimination by including in the design of each plan certain non-discrimination tests. The administrative cost is higher with this type of format, but the chance for a large employer contribution for the owner is very appealing. It is important to know that there are acceptable methods to install a qualified retirement plan that is affordable and that allocates the largest amount for the dentist and those the dentist wants to be involved within the plan.

Who can provide the solutions to the problem of contribution and allocation?

The best place to begin the discussion is with a CPA who has experience working with dentists, and who also has experience in assisting with the design of qualified retirement plans that fit the parameters of the high contribution for the owner, key participant allocation and reasonable administrative cost. These are important factors for a design of a qualified retirement plan that the Internal Revenue will approve. This will mean hundreds of thousands of dollars for the dentist over his or her lifetime that would not have existed had the dentist ignored the ability to adopt a retirement plan that fit his or her needs.

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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Louis Malcmacher
DDS MAGD
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Dentistry and The Recession

I just returned from speaking at Alabama and Texas AGD Annual Meetings and I was blown away. Here were these dedicated dental professionals, gathered together to learn more about better dentistry. Didn’t these dentists know that we are in tough economic times? Are patients really paying for any kind of dental treatment, implants and esthetic procedures now? Were these dentists just fooling themselves, or were they being eternal and naïve optimists?

In reality, these dentists know exactly what they should be doing during an economic downturn. I speak to many dentists every single week and for some, you would think that the end of world is near. None of their patients are going ahead with elective esthetic cases, they can barely talk patients into doing standard crown and bridge, and their revenue is falling rapidly. Other dentists I speak to are holding their own during this time, they are doing more basic bread and butter procedures and their production is maintaining at or just below their 2008 production numbers. A third group of dentists are out there producing like they have been doing for the past few years. Their numbers are up, maybe not as much as they would like, but definitely up. They are still doing a number of elective implant and esthetic cases, and their practices are growing.

What is the difference between all of these dentists? Certainly, there are possibly differences in the economic standards of their diverse patient populations, but that is likely not the answer here. The biggest difference that I generally find, during good times and certainly when you hit a rough economic patch, is the mindset of the dentists and how they are personally responding to what is happening economically.

If your mindset is that times are really terrible and people have absolutely no discretionary income, then without even knowing it, you will be presenting only very basic treatment and you as the dentist will truly steer away from doing elective dentistry, giving yourself the excuse that “times are bad.” Even though you may have fewer patients going ahead with elective treatment, there are still many patients out there that will always pay for what they want. If this is your mindset, then you will go ahead and run your practice the way that you always have and you will see the fruits of your labor. In other words, your mindset is a self-fulfilling prophecy.

My experiences traveling this summer and giving lectures in some of the major tourist cities such as New York, San Diego, Los Angeles, and Chicago has shown me that streets are still packed. From Times Square to the Miracle Mile to the Gaslamp Quarter, I’ve seen American consumers who are on vacation and having a good time. These consumers are the same patients who you may have been afraid to present a veneer or implant treatment to, who are taking that same money and going on vacation or spending it on a new big screen TV.

Focus and learn about the areas of dentistry that patients want. The most beautiful and minimally invasive Aurum Ceramic Cristal Veneers are finally here, offering outstanding esthetics with no/minimal prep veneers that will not look too bulky or too opaque. Aurum Ceramics will work with you throughout the entire case to make sure that you and the patient get the esthetics you desire. What about laser dentistry with a hard and soft tissue Lares Research Powerlase AT laser that reduces the number of injections that you have to give, resulting in more comfortable dentistry. Patients hate injections and in my opinion, this is the best laser on the international market - and it comes with a money back guarantee. They will even bring it to you and let you try it out, how many other companies will do that? Make life easier on yourself and get a V3 Matrix System by Triodent to get great posterior composite restorations with amazing proximal contacts. Try out their Triotrays as well. Then there are narrow diameter implants like Atlas implants by Dentatus that easily create a denture that snaps into place. It is the easiest mini-implant system to use because it does not rely on metal housings and O-rings which many times can be difficult to manipulate.

At the Texas AGD and Alabama AGD annual meetings, there were dentists in the audience that have been using all of the above lab, laser, V3 composite matrix, and mini-implants, and they absolutely love them because they are all prime examples of faster, easier, and better dentistry with great patient outcomes, which makes for very happy patients.

And of course, then there are entirely new line extensions that are coming into our offices – Botox and dermal fillers for every dental practice. Learn a new skill and see how it fits it in perfectly with everything else that we do. I have trained thousands of dental professionals about these procedures and it is quite satisfying to me to watch dentists grow in the ability to satisfy patients and give them better overall results. (By the way, Botox and dermal fillers have held up quite well during this recession!) Why in the world should a patient have beautiful teeth but thin, unaesthetic lips and wrinkled lines around their lips and mouth? Well, now you as a dentist can provide dental and facial esthetics to give them great looking smiles that include teeth and the surrounding soft tissue. Go to my website www.commonsensedentistry.com for more information on Botox and dermal filler training for every dental practice.

Recessions and poor economic times are not new to dentistry. In my career, this is probably my fourth time we have gone through this kind of situation. What should you be doing in a recession? It’s a great time to reevaluate your practice, go back to work on the fundamentals of building a great dental team, evaluate your marketing, come up with new ideas, and learn new skills so you can deliver more services to your current and new patients.

Economically, dentistry’s rise over the last five decades has been one step back in weaker economic times and then ten steps forward when inevitably good times come around again. You need to prepare for that jump in your practice, and now is the best time to do it.

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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