How to Buy a Good Practice and Ruin It

During my years as a practice owner, I’ve noticed a pattern. When someone near my office sells his or her practice, I get an influx of new patients. Believe me—I made no effort to market to these patients. It’s just that I know when someone near me has retired: His or her patients tell me about it during their first visit to my office.

Why does this happen? Why do patients leave the new practice owner?

There are some practice transition mistakes that I’ve noticed. I avoided these mistakes when I bought my practice. But don’t worry, I made plenty of others along the way, but that is the subject of a different blog.

I realize that when you purchase a practice the temptation is to go in and update the equipment, completely remodel the office, etc. DO NOT DO THIS. 

When you purchase a practice, the patients are already going through a seismic change—you. People do not like change. In fact, people hate change. That is why they are not happy about the fact that the face they will be staring up at during their appointments is a different one.

If you want to lose patients, then change things in the office. Change the wall colors, carpeting, and staff; introduce new high-tech equipment that they’ve never seen before. These changes will chase them away.

Think about this: If you go in and change the doctor, carpeting, equipment, and more, what is the difference to the patient between that and going to a different practice altogether? Either way, the patient experiences many changes. Patients would like to be able to come into the new owner’s practice and think to themselves: “Well, at least everything LOOKS the same.”

When can you begin making the changes you want? Wait until you’ve been there a year. This allows most patients to see you twice before seeing other changes in the practice. If they only come in every six months, it will take a year before they have cycled through you twice. At that point they will no longer see it as the previous dentist’s office. They will see it as your office. As you introduce slow change, they’ll be happy for you. I try to make changes in my practice once or twice a year. Slow changes are best.

Do you hate the lime green color on the walls? After a year, you’ve earned the right to change the color. But leave the ugly carpeting in place. You’ll get to that in six months. 

Andy Alas, DDS

Don’t Sweat the Small Stuff

The best way to follow the admonition of “don’t sweat the small stuff” is to define just what you might consider the “big stuff.” A few weeks ago I would have told you that I was right in the middle of the big stuff during my return flight from Phoenix. I had been to Scottsdale, Ariz., at the Spear Campus for four days of CEREC training and was eager to get home and put my new knowledge to work. The last flight from Phoenix to Fayetteville, Ark., is at 3 p.m. PST, with a usual switch in Dallas, and it arrives home around 9 p.m. CST. That weekend, however, there were storms everywhere in Texas and the Southeast.

When we got to Dallas, we circled the airport for almost two hours and then had to go to Houston to refuel. At first, we were going to get back in the air in Houston about 20 minutes after landing. But that was postponed several times until it was at least 90 minutes before we took off back to Dallas. As we approached Dallas an hour later, the pilot came back on the radio and announced that we were approaching Dallas but would not be able to land due to the plane’s radar failure. (Getting to be big stuff yet?) We turned back to Houston (another hour), entered the now closed terminal, and began the wait to see what plans the airlines had for the 100 or so passengers on board.

Normally, if flights are cancelled due to weather, the airlines are not obligated to do anything for you but find the next available flight. However, because the flight had mechanical issues, they agreed to put us up in a hotel, provide cab fare, and help us find another flight. I have a sneaking suspicion that the pilot actually did us a favor and that, when we got to Dallas, he was told that we would have to circle some more and he didn’t want to put us all through that again—so instead he claimed “equipment malfunction” and turned us around. I’m not going to mention the airline, because I wouldn’t want to get him in trouble because of what happened back in Houston.

We landed in Houston around 2:30 a.m., with more than 100 tired passengers, and some very angry ones. The terminal staff available to help us consisted of three people from our airline and four from the neighboring sister airline. A few of the passengers were quite put out and they seemed to think they were the only ones with a schedule to keep. I was somewhat bothered, because I had a schedule for the next day, on Monday, that had the potential to be one of my best production days in more than a year.

Realizing that there was nothing to do about the weather, most of us resigned ourselves to let the airline personnel do the best job they could and not hassle them. A few passengers, however, did a lot of unnecessary ranting and railing. I must say that I wish I had a whole staff of people with the calmness of the young lady in charge and the ability of the rest of the staff to follow her lead. They did an amazing job of staying on point and calm during the entire process of getting us lodging and finding many of us connecting flights.

It was 4:30 a.m. before I got into a room and 9 a.m. when I had to return to the airport, but at least I had a short nap, shower, and a change of clothes. I got to my house around 6:30 p.m. that Monday, 27 hours after leaving Phoenix. Although I had to reschedule my entire day, I found my patients understood and rescheduling was not a problem. Now that a few weeks have passed, I realize my life was not changed or damaged by this hiccup in time. So, what seemed like a big deal at the time was really just small stuff.

Lesson learned: Defining the big stuff should result in a short list. My family and their well-being are at the top of mine. That requires maintaining a strong and profitable work environment, but not one that dominates time with family. You can make your own lists, but keep them short. Don’t make a list of small things to sweat. If you stay focused on the things that are important, there will not be small stuff to sweat. 

Terry G. Box, DDS, MAGD

Paying the Price for Having It All

The first week of May came hard and fast for me this year. Last year, I was bored out of my mind, too pregnant to work, and just watching the minutes go by. Now I was getting ready to celebrate by son’s first birthday, whose first year flew by in what seemed like days. There was just one minor issue: the American Academy of Cosmetic Dentistry meeting.

I started going to this meeting annually when I was in my residency and only missed it last year for obvious reasons. I did not want to miss it two years in a row. Since the meeting went from Wednesday to Saturday and my son’s birthday was on Friday, I knew if I went that I could only go for a few days since there was no way I was missing his first birthday. My brilliant plan was to take a six-hour flight to San Francisco on Tuesday after work, and then take the red-eye back to New York on Thursday night.

I was determined to make this plan work. I figured I would get enough sleep on the plane—like most parents of young kids, I could pass out just about anywhere after 9 p.m. The jet lag after arriving was a little rough, so on the two mornings I was in California I ended up waking up at 4 a.m., unable to go back to sleep and showing up to the convention center bright and early for breakfast. When I got back home to New York, I was extremely tired, but so happy to be reunited with my baby and to begin preparations for his big birthday party the following day. I was exhausted, but I knew that if I just made it through the week, everything would be all right.

Well, I did make it through the week. The week after? Not so much. As the weekend came and went and all of the excitement and adrenaline of the birthday celebrations started to die down, I started feeling extremely tired and achy, but I just attributed it to my body trying to recover from the previous week. On Tuesday, I felt like I had to lie down several times during the day when I was at work. When I was leaving work, I was extremely cold, even though it was 80 degrees outside. All I wanted to do was lie down and go to sleep. It turned out that I had a 104-degree fever due to a case of strep throat. It was bad. My doctor phoned in an antibiotic prescription for me that night. My fever went down by the next morning and I was feeling much better after 24 hours. It was the first time that I had ever taken a sick day since I finished residency, and I still feel guilty about having to cancel patients.

Anyway, the moral of the story is… don’t overexert and overschedule yourself, because your body is smarter than you are and it will make you pay if you try to stretch its limits. Don’t worry though: I’ll be in San Francisco in June for the AGD’s annual meeting! I just won’t be taking a red-eye to get there.

Have a great week!

Lilya Horowitz, DDS

Summer Recharge

I love what I do. Dentistry is not only artistic but also rewarding. It’s probably more artistic in today’s world than it ever has been. People are more aware that their dental health is an important part of their overall health. And we have you, the AGD, and other organizations to thank for that.

I also love my patients—most of them. Of course there always will be those few who seem to make or break your day. And case work doesn’t always go as smoothly as we’d like. And sometimes equipment breaks down. Then there was the time all three of these happened on the same morning. My last day before a long-awaited vacation included all three mishaps and then some. That’s why we occasionally need to recharge.

Somehow folks know when I plan on closing the office, which creates an incredible bottleneck of patients who “have to be seen” before I leave town. The day before our 6 a.m. flight, a walk-in claimed that the filling I had recently put in had fallen out. I took a quick look and saw it was another tooth, but he didn’t want to hear it, still giving me grief for using inferior materials.

I managed to extricate myself and went back to preparing the four veneers I’d started when the suction went out and the high-speed stopped. The compressor and vacuum simultaneously shut down. I had to tell both patients that I couldn’t treat them until I returned from vacation or they could see my on-call backup. They weren’t happy and neither was my blood pressure. How does an artist paint without brush or pallet?

In the U.S., most folks get a set amount of vacation time per year. Typically, it’s not enough, although some people are able to finagle exceptions. I’m one of those exceptions. I feel more attuned to my patients when I’ve taken time off to just relax. My wife might take issue with that statement because what she considers relaxing and what I consider relaxing can be two different things. I am an avid reader but I can sit still for only so long. Hiking, biking, skiing, climbing, whitewater rafting, etc. are my way of chilling. I usually get enough reading in during the plane ride to wherever we are going.

Leaving behind the stress of that out-of-control situation in the office, my wife and I flew to the Galapagos Islands off the Ecuadorian coast. For me, chasing sharks around reefs in my snorkel is fun and relaxing. And you can’t hate the silly way blue-footed boobies walk or the way a flightless cormorant poses on a lava flow, its sad-looking wings spread out like it’s trying to fly. I think the other birds make fun of them. Iguanas are not supposed to swim but those that live in the isolated environment of the Galapagos do. Unafraid, they come right up to your face mask, blink, and swim away. They’re really quite docile but sea lions are incredibly friendly and curious. They playfully bump in to you in the water, like a dog that’s happy you’re home.

I’ve included three pictures of me and my wife, who is my office manager. The first picture was taken during that last day of work when everything was going wrong; you can see that it’s my fault. The second one shows us traveling via a local airline, taking off from the mainland to the islands. The last is of us relaxing together in the almost warm waters at the equator.

Now that I’m back in the states, I can concentrate on delivering good dental care to my community. And when—not if—things go wrong, I’ll be able to calmly cope with them.

Next stop…a resort/spa in the beautiful mountains of West Virginia. My wife arranged that one.

Jim Rhea, DMD

Treating with Dignity

Our provincial elections are about to occur and my thoughts turn to how fortunate we are to live in a place where social democracy is allowed to flourish and succeed. We have freedom to act and behave reasonably, to dream and find a way to bring that dream to reality, and to have a government that is freely elected, governs according to our collective wishes, and looks after our population, as only a government elected by the people, acting for the people can. Corporations cannot do what governments do. And I am grateful for the birth lottery that has my family and me living where we live.

In my practice, we try to treat all of our patients—regardless of age, gender, income, religious background, sexual orientation, and more—with compassion, care, and dignity.

Grumpy Dave came to my office some years ago. He came to me from a place called “1658 house”. It’s a home where former addicts live while they are putting their lives back together. It is a place where the residents, with some staff, support each other through their healing and re-entry back into society and their families.

Dave was an alcoholic. He used cocaine as well. His mouth was a mess after years of neglect. His clothes were clean but old. His face was scraggy but clean shaven. He looked old but was younger than I am. And he was nervous coming into the dental office after so many years of neglect.

Physically, he was now clean and he had been sober for a long time. But he was in considerable pain. He had several abscessed teeth and rampant caries, mostly in the molar region, that were hopeless. And I was the third dentist he had seen. The other two treated him like he was trouble, like he did not deserve the time, care, and attention they provided to their other patients. The patients and staff in the other offices did not like how he looked, and he was judged based on his appearance alone.

But Dave had a story to tell. For all of my new patients, I book one hour with them. You cannot devise a true health care plan for someone if you don’t know his or her story. Dave was born in England. Lived in Ontario. Was a father to a now adult girl. He had not seen his child in years, was estranged from his wife, and no longer lived in the same province as they did. But he cleaned up. 1658 house was giving him a second chance at life. He was finishing a diploma program in counseling, so he could help support people just like him, because it had made such a difference in his life. And the provincial government had a dental health care plan to assist in his basic oral health care, allowing us to provide good comprehensive care without concern for Dave’s financial ability to pay for the treatment. The government plan paid less than my fee schedule, but I felt that Dave deserved the break. The treatment meant more to him than the money did to me, and the number of people I see who are like Dave is very low.

Dave had been down and out, but he was back, looking for an opportunity to make amends, to contribute, to turn his life around. And we were in a position to help him reach those goals.

We treatment planned to remove the hopeless teeth, to eliminate the cavities on the teeth we could keep, and to replace the missing teeth with dentures to provide good function. He ended up with a complete upper denture, partial lower denture, and 10 lower teeth had fillings completed. We also provided periodontal care to restore his soft tissue health as well. By the time we were done, he was out of pain, eating better, and feeling much better about himself.

He found his daughter and she moved out to Calgary to be near her father. He was thrilled to play a positive role in his daughter’s life. He finished his diploma program and 1658 house hired him as a full-time counselor so that he could help others in a place that was so helpful for him.

Dave always seems to be grumpy, and that is why he has the nickname, but he really is grateful. So grateful that he wrote me a lovely note saying that at a time when he was struggling to re-enter society and put his past behind him, we treated him with dignity and respect, took the time to listen, and to come up with a plan that was going to work for him in his situation. We were touched by the gratitude, and he deserved nothing less than what we provided for him.

Everyone has a story. We all have a book inside of us waiting to be written. But the best of all of this is that we live in a place where social democracy gives us the opportunity to help and it gives us great joy to provide that assistance to people who want to help themselves.

Thanks for reading.

Warm regards,

Larry Stanleigh, MSc, DDS, FADI, FICD, FACD

Wellness

One of the most encouraging and worthwhile programs my practice has put in place to date was a Groupon deal that we started running nearly three years ago. It has brought in people from so many walks of life—young, old, employed, retired, in need of a cleaning, and some in need of much more. We didn’t start the program to make money; we started it to do our little part in getting patients who really needed to see a dentist in the door. There are many hurdles people face these days when it comes to dental care, and most of it is based on money or fear. This Groupon offering essentially took the money part out of the equation and gave us the opportunity to educate, communicate with, and care for individuals with significant dental needs—individuals who, otherwise, likely wouldn’t have seen a dentist.

But we noticed one thing about many of these patients. Once we broke down the barrier of getting them in to see us for the first time (and, for some, it was the first time seeing a dentist in five, 10, or 20 years), there was still a significant financial burden when they were presented with the necessary dental treatment. The absolute last thing on our mind was to scare people away, but by no fault of any of us, it’s what’s happened on many occasions. We realized we had to keep these people coming back, not just for their treatment, but for their routine preventative visits. You see, it’s these regular visits that allow us to catch cavities before they get big, infections before they start, and fractures before they break. It keeps patient pain and discomfort to a minimum, but also it keeps their treatment costs down. “Heroic” dental treatment, meaning significant work to save or replace a tooth, is always more expensive than a smaller, preventative measure. And so we embarked on putting together something that could benefit these patients and many others like them.

We put our collective (tiny-brained) heads together and came up with a plan—a WELLNESS plan! It’s a yearly membership program with a reasonable yearly sign up fee (cheaper than two regularly priced exams/cleanings!). It provides patients with no cost preventative exams, cleanings, and X-rays while also discounting our fees for restorative and cosmetic procedures. There is no maximum allowable benefit and no third-party insurance company to hassle with. It’s completely in-house and even provides a discount for additional family members.

It’s in our hearts to help people, but we also run a business—one that employs several doctors and many staff members, so it has to remain profitable or everyone loses. This type of program allows opportunity for both, and it is our little part in helping to combat the access to care issue we’re facing in our profession. Now we’re knocking down the barriers to dental wellness, one fluoride varnish at a time!!

Donald Murray III, DMD

Our Future in Dental Education

I was raised on the outskirts of a small city (about 30,000 people), and when I was a kid I really believed I lived “way out of town.” My opinion was based on what I overheard regularly: “Colleen’s parents will have to pick her up because I am not driving all the way out there to drop her off.” So it became the norm for me to assume that no one would drive to my parent’s home to either pick me up, drop me off, or deliver their own child to have a sleepover.

My parents’ house was simply about seven miles from anything or anyone. As I matured, I was always the one to have to drive—I was the farthest out, so I picked up everyone along the way. What this created in me was an expectation that I would always have to drive a distance to get to events and places. Other than the four years I lived on campus for undergraduate college, I have always had quite a commute.

Even in dental school when I had the opportunity to choose where I would live, I chose a place that was a distance from the college but yet close enough to where my fiancée lived. Once I began my professional career, I recall nearly seeing heads spin when I looked into this amazing practice (that I’ve now been a partner of for 12 years) that was about 46 miles away from our home, one way! I suppose my point to this background is that jumping in the car and having to drive 30 minutes seems like the norm, and once you get to 1.5 hours, it is expected if you want to see great theater, sporting events, and without question quality continuing education (CE).  

Obviously, as a Fellow in the AGD, I consider dental CE very important, and finding top-notch courses can be quite a challenge at times. I am blessed to be in a state where our existing Michigan AGD provides great opportunities several times a year—all within a reasonable distance—for me to participate in. 

Recently our board in Michigan, in an effort to provide the same amazing quality CE to all its members, made a decision to take a hands-on course to the northern area of our state. It is scheduled for later this year. I hope to report that it was a success. 

For those who are truly in rural communities, I understand the frustration with attempting to maximize your time and minimize your expenses while receiving top-notch courses. This is the reason I am IN LOVE with the AGD’s new webinar series. 

Take, for example, one of the current series being provided—the Pediatric Dentistry Webinar Series. The series consists of three different webinars (which are counted as LIVE lecture courses!) and they are only $150 for 4.5 hours. The best part??? I don’t have to drive ANYWHERE!! I am tucked in my comfy chair, in my comfy clothes, and I never have to leave my house. Also, let’s review the ROI on this one; it breaks down to less than $35 per hour for AGD-approved lecture hours without any additional expenses!!!!! How can you beat that? And for those of you who aren’t AGD members—you should consider joining, but that’s a different discussion—the cost is about $55 per hour if you purchase the three-part series.  

In contrast, if I registered for a regular run-of-the-mill lecture course, of AGD-approved quality, I used to base the value on, say, if it was about $100 per hour, it was fair and reasonable. I, of course, still had to drive myself and potentially pay for parking and lodging if it was far enough away.  

I love the future that I see with education in its entirety. I am sure that I am not the only one who still has text books, but we are looking at the past. Electronic versions of everything are our future, which we have been embracing clinically for a decade with the onslaught of paperless charting, digital radiography, and now, digital impressions. So shouldn’t we be embracing live interactive webinars in our pursuit to achieve the very best in ongoing dental education? 

If you haven’t checked it out, you are missing a great opportunity!! In addition to the pediatric dentistry series, there are series on oral surgery and dental sleep. If you can’t participate in these three-part series, then simply do it à la carte—pick the course that interests you and DO IT! 

Colleen B. DeLacy, DDS, FAGD

Clinical Tips

This time around I want to give you a gift. If I may, I would like to offer some clinical tips that have made my life easier. Many of these may be old news to some of you. But I’m willing to bet that at least one person out there will benefit. Enjoy some of my hard-earned knowledge. If you ever get saved by one of these, just drop me a note. I’d like to hear about it.

Ankylosed teeth: You’ve been there. A mid-teenaged patient is referred to you for extraction of a primary molar. Everyone looks at the tooth and thinks, “I can’t believe it’s still there.”

Do yourself a big favor and tap that tooth with the handle of a mouth mirror. If it sounds hollow you have an ankylosed tooth in front of you. Believe me, you’ll immediately identify that sound.

Now you have a decision to make. Some of you are awesome at extractions. You say to yourself, “Bring it on!”

If you are like me, however, you’d rather refer. I always enjoy the call/letter from the oral surgeon, telling me about the difficult extraction: “How did you see that one coming?”

Multiple anesthetics: Mandibular blocks—admit it; this is the area with your lowest success rate. You get it most of the time, but many times you don’t. I learned this simple trick and it dramatically increased my success rate. Sure, it’s not a 100 percent guarantee, but it will get you much closer to that goal.

In dental school I was taught to administer two carpules of lidocaine. If that didn’t work, you were instructed to administer a third carpule. This does work many times. However, many times it does not.

This is what I do now: I administer one carpule of lidocaine and one carpule of carbocaine. What happens with much more frequency? I hear the patient say, “My whole face feels numb.”

Lower second molars: If you are like me, you cringe at the thought of preparing some second molars. You know which ones I’m talking about. They are SHORT. That upper palatal cusp has ground them down. Eventually that upper ends up cracking that lower.

So I’ve been doing patients a favor. If I see a pointed upper cusp, I contour it. I usually do this if I’m working in that area anyway. Usually I’m doing a filling. Since it’s numb anyway, I contour that cusp. Call it whatever you want—contouring, equilibration, occlusal adjustment, etc. But the result will be that your patient may not need that crown any time soon. Wow, two lives simplified.

Dry socket: I cannot claim credit for this one. I learned this from KISCO’s newsletter. It has saved me several times.

I realize that there are as many dry socket cures as there are dentists. But if you are in a pinch, this one works.

Crush an aspirin and mix it with eugenol (the liquid in that zinc oxide eugenol package). Place the resulting paste in the socket. An amalgam carrier works just fine for this.

I’ve actually had patients call me from my parking lot to tell me that it is already feeling a lot better. Thanks to Dr. Joe Steven, Jr., for that one.

Anyway, I hope this helps. If you have any game-changers, please let me know.

Andy Alas, DDS