September 26, 2016
This is my annual “don’t jump off the bridge” message to dentists. September is traditionally the slowest month of the year for production and collection. And September is the final month of the third quarter (July through September) which is the slowest quarter of the calendar year. But every year, dentist forget this – panic – and deduce that their practice must be succumbing to the competition. The knee-jerk response is to lower fees and charge less.
Don’t fall into that trap. Please realize and understand that there will always be someone who can sell what you sell for less money and deliver it quicker than you can. The eminent business guru Seth Godin recently posted that “once you decide to become a cheap commodity, all the choices you made to be a non- commodity fall victim to your pursuit of cheap.”
The solution is not to try to compete on price but to compete on quality. Your competition is not from the dental office across the street. It is from college tuitions and vacations and automobiles.
Exceptional quality clinical dentistry in conjunction with a consistent commitment to exquisite customer service at every level will have people in your town raving about how well they were treated, how their time was respected, how they were given choices of treatment, and how they felt like a person and not a number.
Practices with “busyness” problems are often unwittingly their own worst enemy. Business hours Monday through Thursday – 8 to 4 – shows no understanding of the need to be available. And why would you not answer the phone over the lunch hour? How about not allowing someone to leave a message?
The good news is that you are still standing. Now that September is almost history, get back to basics and concentrate on making it easy for people to do business with you. When people know how much you truly care about them, good things will happen. And as I’ve said many times regarding customer service – it is not hard to be good when everyone else is so bad!
September 12, 2016
My last two blog posts have discussed wealth accumulation strategies guaranteed to provide the necessary funds for a comfortable retirement. Qualified pension plans and whole life insurance are relatively easy to implement provided you can find the discipline and the available cash to contribute. Owning your own real estate is a horse of a different color, and requires much more of an entrepreneurial spirit and creativity. But the returns can be outstanding.
Instead of paying rent to the landlord, be your own landlord! It is easy to set up a separate entity to own the real estate. The rent payment is made with pretax dollars and of course is a 100% tax-deductible business expense of the practice. And you can – within reason – pay an above market rate to reduce your debt sooner.
I would advise this for any dentist planning to practice for another 15 years or more. Over 15 years – let’s say your current rent is 5K/month. That equals 60K/year which equals a staggering 900K over 15 years!! And we know it will be more than that because rents customarily increase by 1-2% every year. All that money is gone. Disappeared. You have absolutely nothing to show for it. Unfortunately, it is all part of the cost of doing business. If instead, you owned your space and retired the mortgage over that 15 years with your rent payments, you now have a debt free property that in the worst-case scenario has maintained its original valuation.
Here is another collateral benefit for you to consider. Studies have shown – and I have seen this happen with many of my clients over the years – that if you move your office even 4 or 5 miles but stay within the same town, every existing patient remains with the practice and new patient flow increases by 35 to 40% in the first year! And amazingly enough, it continues at that increased level for the next five years! I’m not sure why this happens, but it does. By buying an existing condo space or professional office or actually building a new structure, you also have the potential and the opportunity to design a better layout with room for growth. And money currently is so cheap – at historic low rates – that I see mortgage costs not exceeding – or minimally exceeding – your current rent costs. I honestly don’t believe there has ever been an easier time for dentists to borrow money.
So take a hard look at your current occupancy arrangement and explore your options. Saving for retirement by making contributions to pension plans or a whole life policy requires finding additional dollars. Saving for retirement by owning your own property simply means keeping the dollars you are currently paying to someone else!
August 29, 2016
In my last blog post, I discussed the many benefits of qualified retirement plans. As great as they are, however, sometimes these plans are not the proper economic fit. In one example, let’s talk about a doctor who is much younger than the staff. And perhaps there is an especially large staff. My rule of thumb is that if the doctor can keep 78% or more of the total contribution, then that is a favorable situation. But in the situation I am describing, the doctor may only be ale to keep 40 to 50% of every dollar contributed.
Another example might be a doctor earning enough money to contribute more than the 401(k) maximum. And a defined benefit plan coordinated with the 401(k) would allow him/her to do this. But again – with an unfavorable census – with some staff members as old or almost as old as the doctor- the costs to do this are prohibitive.
Welcome to the world of a properly designed whole life insurance policy that can serve as an amazing wealth accumulation vehicle. And if you own your business as most dentists do, there is no requirement for other employees to participate in the plan. So the entire dollar amount that you want to set aside for retirement goes only to you! There are numerous benefits to using whole life as a retirement strategy.
• There is guaranteed protection of your principal. The cash value accumulating in the plan is not subject to the fluctuations of the stock market.
• There is a guaranteed rate of return. Usually with a top line insurance company, that rate of return is in the area of 4 to 5%.
• The money in the plan accumulates tax-deferred. The concept is similar to a Roth IRA. When you put the money in, it is with after-tax dollars – so there is no sheltering effect as when you contribute to a qualified plan. But when you take the money out, it is tax-free!
• There are no age restrictions or limitations as to when you can withdraw the money. With pension plans, there may be penalties if you withdraw before age 59 1/2. Also, you must take required minimum distributions from your pension plan starting at age 70 1/2. Of course, those distributions are taxed at whatever the ordinary income tax rate is at the time of the withdrawal.
• You can also borrow from the cash value of the whole life policy – at any age and at any time – without having to pay a tax or a penalty. This is a big benefit compared to the many restrictions you would encounter if you borrow from a qualified plan.
• Of course, the death benefit of the whole life policy is guaranteed for the rest of your life. That death benefit is tax-free to your beneficiaries.
• With these newer well-designed whole life policies, there are also riders included for disability and long-term health care. These are almost too good to be true.
I would certainly encourage you to consult an expert on the many advantages of acquiring a whole life insurance policy. Randy Fine of Robert Fine & Associates is as good as it gets. Randy is extremely knowledgeable and creative with years of experience working with dentists and other high net worth individuals. He has helped many of my clients and I feel totally comfortable recommending him. You can reach Randy at 508-889-6329.
August 15, 2016
I have always been of the belief that if early on – probably by age 30 – you start “saving your age in thousands” in a qualified retirement plan – e.g. 31K at age 31, 32K at age 32, etc. – and you continued to do that for the next 35 years – you would accumulate enough money to comfortably retire at age 65. That amount would easily be in the three and half to $4 million range – even with conservative return expectations of 5%.
You could then continue to maintain your current lifestyle and work because you want to and not because you have to. I’m speaking from my own personal experience and my observations of successful clients over these many years.
In my opinion, qualified (approved by the US tax code) retirement plans are like the eighth wonder of the world! The amount of the contribution you make to the plan shelters your taxable income for State and Federal. So if your W-2 income was 250K and you made a contribution of 40K, your reported taxable income would be 210K. The money contributed to the plan grows and compounds tax-deferred until the money is withdrawn. You pay ordinary income tax on the amount of the withdrawal when it is made. Contributions that you make for staff are fully tax deductible as a business expense.
If you are lucky enough to have started down this path an early age, you are to be congratulated. Just continue to stay the course. But many doctors were not that fortunate. Maybe they were uninformed – or didn’t have the discipline to save – or simply didn’t have the money available. Now they are age 45 or 50 – finally have more disposable income – and are recognizing they are seriously behind the curve on retirement planning. How do you catch up?
There are two types of qualified plans: defined contribution or defined-benefit. 401(k) plans seem to be the most popular and they are a type of defined contribution plan where employers can match their employees’ contribution up to a certain percentage and also make additional contributions under a profit-sharing feature. For 2016, the maximum allowable employer/employee contribution limit is 53K or 59K for those over age 50.
A defined benefit plan is a cash balance pension plan under which an employer credits a participant’s account with a set percentage of his or her yearly compensation. This can be paired with a 401(k). It often is a fabulous strategy for older doctors much closer to retirement age than their employees. With a favorable census, you have the opportunity to annually put away 100K or more. The plan by law must stay in place for at least three years. When the doctor retires, the plan can be terminated, and the monies that have accumulated for the doctor and for the staff can be moved into an IRA.
The rules and limits on retirement plans change frequently. You need a true expert in this field to advise you. And I would choose this person separate and apart from a financial advisor who would be making investment choices.
According to recent statistical data, if either you or your spouse live to age 65, at least one of you will live to age 90! And just in case you forgot, it takes a lot of money to live well. So do yourself a favor and at least get informed. I highly recommend Seth Larner at Compass Retirement Consulting Group. You can call Seth at 603-661-9330.
August 2, 2016
It is a privilege to work, and don’t let anyone tell you differently. But the best scenario – especially when you are older and getting closer to the end of a clinical career – is to work because you want to work and not because you have to work.
One of the major reasons that we remain in a “seller’s” market for dental practice transitions is that there are fewer practices for sale than the number of doctors looking to buy. Many doctors who were planning to retire at 65 have come to the realization that they can’t afford to sell and still maintain their current lifestyle. For the first 11 years of the 21st century, the stock market was a bitter disappointment with essentially no growth. And many doctors, understandably nervous when the market crashed and lost so much value in 2008 and 2009, sold to protect their portfolio but unfortunately never bought back in as the market totally recovered.
So age 75 or 72 has become the new 65. Doctors continue to have to work longer than they ever thought they would. For whatever reason – bad advice, bad execution, lack of understanding – these professionals never anticipated how much money they would need in retirement. Life expectancies continue to lengthen. Statistically, if both you and your spouse make it to age 65, one of you will live to 90! And living longer obviously requires lots of cash. So how do you prepare yourself for this challenge? How do you make the supposedly golden years truly golden?
Over the next few months, I plan to write a series of blog posts all about ways to aggressively save money. So many of the rules have changed, and more products than ever before are available to the motivated and informed doctor of any age. Stay tuned. As always, I will look forward to your comments.
July 19, 2016
Facebook made the decision a few years ago that it would suppress the number of people who see the posts on a business page unless you pay to boost the post. This is the classic drug dealer business model – get someone hooked – take it away – and they will pay. It still benefits business pages to reach the audience that has LIKED the page since these folks have “opted in” to be marketed to. As dentists, we have to decide what to post and what to promote. You should understand that a boosted post receives about 500X the exposure of a non-boosted post.
While Facebook allows boosted posts to be somewhat targeted to an audience, those targeting opportunities are far fewer than if you used Facebook Ads. An ad campaign is a step up in cost and involvement. For those ads, in the past, Facebook would allow you to target based on age, relationship status, geography, and the likes and interests. While these are great ways to target an audience, it still was very broad targeting and could present challenges to an advertiser.
In the last few months, Facebook has made changes to its Ad Platform and now lets advertisers get really specific when it comes to targeting. Now you can target by household income. You can also now target people by where they work and even their job title. This is pretty exciting stuff! For dentists trying to promote more expensive procedures like implants, veneers, and adult orthodontics, you now have the ability to specifically hone in on prospective patients like never before and really speak to them and tell your story.
Marketing on Facebook is undoubtedly going to continue to get more expensive as more people realize the value it holds. There has never been a better time to utilize this platform to increase brand recognition and tell your audience why your practice is the best practice. That being said, I believe it is tough to do this on your own. Unless you are extremely Internet and social media savvy, you need a real Facebook expert to help you decide on a program and a budget. I continue to recommend Heather LoGrippo, founder of Expose Yourself Public Relations. She can be reached at 617-957-3868 or exposeyourselfpr.com
July 7, 2016
This is my 20th year working full-time as a dental practice management consultant. If I had to make a decision about the most common “issue” that I witness in a dental practice, it would be the inability of the “back” and the “front” to get along and work in a harmonious and supportive relationship. Honestly – no other “issue” is even close! While it is rarely a flat out war, it is definitely prevalent in varying degrees.
It defies logic. It remains a continuing source of frustration to the doctor/owner. Why can’t these kids play happily together in the same sand box since they are all so capable of performing their own jobs?
Perhaps part of the reason is that the jobs and responsibilities of the administrative staff and the clinical staff are so different. And doctors are usually much more in sync with the clinical staff because they work together in the back. Frankly, many dentists I see are unaware and somewhat unappreciative of the tasks that are performed at the front. So unwittingly, the doctor may be contributing to the problem.
On a typical day, clinical staff complete their tasks – take care of their patients – clean up – and then go home. The staff at the front could work 24/7 and they would still never finish everything on their plate.
Clinical staff in the back – even though they are usually only taking care of one or two patients at a time – are often burdened with reassuring frightened patients or trying desperately to stay on time . Meanwhile, staff at the front are juggling a multitude of tasks. The phones are ringing constantly with questions about insurance, billing, new patient inquiries and changes of schedule. These calls all need to be fielded and responded to at the same time that routine day to day tasks have to be accomplished.
Here are my ideas for solving the dilemma.
1. Switch roles for a day. I believe a lot of problems come from a lack of understanding of other people’s jobs. Let the front desk person observe first hand why the back needs to be given more than a five minute notice that the ten o’clock patient scheduled for a crown prep has been replaced by someone needing molar endo. Let the clinical person understand why the front desk person needs to be informed that a discount was offered BEFORE she starts making the financial arrangements.
2. Have the doctor assume more ownership of the problem. The doctor is the leader of the team. He or she is responsible for creating a happy work environment. The doctor must avoid favoritism of the clinical team and start showing more respect and admiration for the job performance at the front.
3. Institute a bonus/incentive plan for staff. This forces people to work together or suffer the consequences.
4. Focus on having a dynamite morning huddle. It is by far the best way I know to successfully plan for the day ahead while at the same time review the previous day and learn from that experience.
This shouldn’t be so difficult. It is by no means rocket science. In fact, I would reduce this problem to its core by simply challenging everyone to be professional, respectful and mature. Accept the challenge. Eliminate the pettiness and the blaming. Play peacefully in your sand box.
June 22, 2016
I love the month of June! The snow and cold of winter and the dreariness of spring turn into eye candy with flowering trees and bushes, spectacular annuals, and emerald green grass. It is also the time for graduations from high schools and colleges. Kids with their life and future before them – the world their oyster – listen to inspirational and motivational themes: Don’t be afraid to shoot for the stars. Don’t ever give up – the old story of if you get knocked down seven times you get up eight. Don’t ever let anyone tell you that you won’t succeed.
So what if you could imagine yourself now –working in the dental profession – attending that very same graduation, listening to those same themes. Of course you are now older and hopefully a lot wiser with years of life experience under your belt. But maybe you are burned out, or tired, or jaded. Why not use this as a good time to rededicate yourself to being the absolute best dentist you can be. Or the most talented and helpful team member – whatever your job in the practice.
Mohammed Ali recently passed away. One of the greatest fighters all time, Ali is even more famous for his courageous battle with Parkinson’s disease. He wrote these amazing words that totally reinforce the graduation message. “Impossible is just a big word thrown around by small men who find it easier to live in the world they’ve been given than to explore the power they have to change it. Impossible is not fact. It’s an opinion. Impossible is not a declaration. It’s a dare. Impossible is potential. Impossible is temporary. Impossible is nothing.”
The lyrics of Oscar Hammerstein from The Sound of Music convey the same indomitable spirit. Climb every mountain. Ford every stream. Follow every rainbow. Till you find your dream.
Hopefully good food for thought for all of us – no matter our age or station in life.
June 6, 2016
Over the past five to seven years in the dental profession, there has been a significant increased awareness and utilization of marketing automation and reputation management companies. These companies automatically and professionally connect with patients via email, text, voice and social. These companies sync with your practice management software to analyze patient data and send the right message to the right patient at the right time.
The savings in time and the increase in efficiency are huge! Instead of front desk staff spending hours on the telephone, scheduled appointments are automatically confirmed in real time by email or text. Other value added services like re-activating overdue patients, collecting reviews, online appointment requests, family messaging, birthday and holiday greetings all happen seamlessly and contribute to keeping a full schedule of patients.
I would like to suggest that one of these companies – RevenueWell – has separated itself from the competition. Here are the reasons why.
• No contract – with the exception of Lighthouse 360 and Yapi, RevenueWell is the only company that operates month to month with no contract. Everyone else requires a one or two year commitment.
• Exclusivity – RevenueWell is built solely and specifically for dentists.
• To my knowledge, RevenueWell is the only company that is able to notify patients of expiring dental insurance benefits.
• RevenueWell has the capacity to send out a welcome packet to all new patients prior to the initial visit.
• RevenueWell has a large library of pre-built campaigns to promote elective services.
• All communications can be customized and edited for any campaign.
While these six features are important, there are two more that alone make this company worth way more than the monthly fee of $299.
• Treatment plan follow up – RevenueWell is the only solution in the industry that monitors your practice software for unscheduled treatment plans and automatically communicates with patients to bring them back into the office. Other companies can send an email telling a patient the practice offers crown services, and maybe attaching a promotion to this communication. RevenueWell can send the patient an email telling them that they need a crown on the lower right first molar, include detailed cost and insurance breakdowns – and even links to relevant Caesy videos that illustrate the procedures you’ve proposed. Very cool.
• Patient reviews – all of the companies automatically encourage patients to post a review following an appointment. These reviews get posted to a microsite hosted by the company with some, but rather minimal, SEO benefit. RevenueWell has a system that explicitly and easily helps the patient to re-publish their review on Google or Yelp. Reviews posted on these sites are called “direct reviews” and carry much more weight and relevance.
RevenueWell integrates with the three most popular PMS systems: Dentrix, Eaglesoft, and PracticeWorks. My clients report a high level of satisfaction with the product and are especially impressed with the consistent customer service experience and technical support. Michelle Gabrielson at 770-840-5342 will be happy to schedule a demo.
May 24, 2016
Dr. Abraham Verghesi is a best selling author and world renowned physician. In his book “Cutting for Stone”, he tells his residents that the most important organ in the body is the ear. Why? Because to be a great doctor and exquisite diagnostician, you must train yourselves to listen to what your patients tell you.
All day long, as dentists, we diagnose dental problems and offer treatment solutions. Our patients seek us out for our ability to provide answers to their questions and concerns. Why is it then that some dentists are more successful than others in convincing patients to accept treatment? Advanced clinical abilities, expertise in multiple disciplines, salesmanship and communication skills are all important attributes for success with case presentation. But I find the most successful docs are the ones who have trained themselves to listen – to listen intently to what their patients tell them, and to truly hear their patients’ concerns, fears, and uncertainties.
It has been said that we have two ears and one mouth so we should listen more than we speak. Isn’t it interesting that the word “listen” contains the same letters as the word “silent”. So the next time that you are having a conversation with a patient, remember the acronym WAIT- Why Am I Talking?
My take away message – participate in the conversation but don’t dominate the conversation. Be interested rather than interesting, and the results will amaze you!