The Dental Specialist and Referrals

Here is another guest post from our client Dr. Lurie. We are so fortunate to have him share the wisdom he gained for five decades as a dental specialist.

It seems to me that the dynamic of a specialist obtaining referrals has changed.  As we have all noted, private solo practice in the specialties has greatly decreased.  I have heard estimates of less than 7%.  As a retired Oral and Maxillofacial Surgeon, I have personally noted the change in referral patterns and, I think, understand what must be done to encourage referrals.  This wisdom comes from fifty years of practice.  No longer is it enough to take a generalist to lunch, or to have an annual Christmas party.  I think that the whole picture has to be viewed and rearranged.

Firstly, the specialist has to be extremely well trained. He has to be able to get the "word out" about how well trained he is. I would suggest  a curriculum vitae be sent with the announcement of the opening of his practice.  This is important and should be of the highest standards befitting the degree of their excellent training.  While it is important to let folks know where you are located, phone, email etc…, it is paramount to let them understand your qualifications.  This should be updated periodically as new honors and leadership positions occur.  Obviously, with social networking as keen as it is, it is imperative to have the correct team to help in this initial matter.  I have discussed the team concept in one of my previous articles (The Team of Retirement).  This is the first impact that you will have on your referring base.

It is to be assumed that most specialists will be joining an existing practice.  I would still recommend that this initial information (CV and other marketing) get out there so that the new "person" is not relying on the reputation of the existing practice.  Obviously, if the doctor is solo, then it speaks for itself. 

Incidentally, most of these ideas would apply to a generalist starting practice with the obvious difference being that his target marketing prospects would be different.

In the beginning of the practice, personal visits to the referral base is mandatory.  Now the doctor can place the name with the face.    I would also suggest that care be taken to find a convenient time to visit the doctor----check with his front desk and get to know them well.  Lunch is always good if it is possible but a coffee break at an off-time can usually be arranged.  You might want to stop in unannounced just to meet the front office, introduce yourself and make the appointment with them in person.  These first months will require a great deal of leg work and it is wise to plan this out so that you still have proper time to cover your new office and schedule (keep in mind the new IRS standard mileage rates as well – note all of your travel in a journal regularly).  It will be also mandatory that your new staff be well versed in what you are doing so that things run smoothly while you are out and about.  Again, the proper team will be helpful in putting that staff together.  Nobody said it would be easy. 

As time progresses, I would suggest a series of "Munch and Learn" sessions in your office.  This now completes the circle of announcement, face to face, and seeing your office location.  There should be a wall that displays your credentials-----do not make it obnoxiously obvious, but it is a must.  These sessions should be an hour or less and eventually may lead to further interactions (study clubs, etc…) which I will discuss in another article.  Keep them low-key with simple refreshments.  You might want to invite a speaker, present yourself, or even have one of the detail persons from a company at these gatherings.  It does not always have to be about your specialty per se, but could be a practice management tidbit, accounting novelty, equipment demonstration etc. 

I invented a little item that was a big hit and I will share it with you.  After a patient was seen, treated and eventually discharged, I sent them a thank-you note.  What?!? A thank-you note from a surgeon to a patient.  At the same time, a reminder note went to the generalist so that his patient could be kept in his system for recall and follow-up.  Too often, these patients were late in there general check-up because the referring office thought the patient was still under treatment.  Just a little tidbit but it was effective for me.  The marketing angle is to engage the patients to refer to you directly.  Obviously, you then have an opportunity to reciprocate with your referral base if the patient is not "attached" to a GP.  Always, always, always, try to market with your patients. 

I think that the specialist should take a look at the reports that he sends to the referring doctor so that they are sent in good time and are relevant.  I had a personal, handwritten quick note that went out the same day the patient was treated so that the doctor knew that treatment was on-going and active.  If it was a major case, this was followed by a complete operative note etc. so that it could be filed in the patient’s permanent chart.  This is just another means to get your name in front of the generalist and to establish good lines of communication.  This obviously can be done by email, fax etc.  The important thing is to document the treatment clearly and always ask for his feedback if necessary.

These are just a few ideas about getting started and I hope they are of help.  Please do not hesitate to send me you thoughts or questions.  It would be my honor to be of help.

More Mistakes Made and Lessons Learned next time.

Dr. Donald B. Lurie, DDS

email:   donald.lurie@att.net

Phone:     717-235-0764

Cell:         410-218-2228

New Mileage Rates Released by IRS

The IRS has released the 2014 optional standard mileage rates that employees, self-employed individuals, and other taxpayers can use to compute deductible costs of operating automobiles (including vans, pickups and panel trucks) for business, medical, moving and charitable purposes.

The 2014 standard mileage rate is 56 cents per mile for business uses and 23.5 cents per mile for medical and moving uses. It remains at 14 cents per mile for charitable uses. For purposes of computing the allowance under an FAVR plan, the standard automobile cost may not exceed $28,200 ($30,400 for trucks and vans).

The updated rates are effective for deductible transportation expenses paid or incurred on or after January 1, 2014, and for mileage allowances or reimbursements paid to, or transportation expenses paid or incurred by, an employee or a charitable volunteer on or after January 1, 2014. 

In This Season of Thanks, This is How One Dentist Gives Back to His Community

Here is another guest blog from our client Dr. Don Lurie.

It seems to me that in this season of the year, our thoughts should turn to the ideals and morals of our history, of our parents and grandparents and even of the faith that has united and nourished us.  We all hear the expression ""I want to give back" but it is something that has to be nurtured, reflected upon, and then acted upon.  It must be sincere.  I guess that the sentimentality of this season of the year has given me the desire to share thoughts about this so-called "giving back." 

Last month, I discussed mentoring to both our younger practitioners and even to our patients.  This should be extended to anyone who might think that our experience, knowledge, and professional bearing might give them insight into their future and to help shape their career attitude to enable the practitioner to love his practice, his patients and staff, and to guard against the cynicism of just practicing for the dollar.  It is most difficult in this current climate to have these "noble" feelings and it is quite difficult to find the words to just address them.  I almost want to quote scripture to help me find the words and to share what I feel in my heart.  In my blog titled Mentoring Equals Outreach, I have started to share the ideal of gift giving and of thanks giving.  I have also suggested that this is, if sincere, a great function for marketing of your practice.  But do you know what? It just makes you feel good and that good feeling should be expanded.  As it was handed down to us by someone or at some place, the good that we have done, are doing, and should continue to do (even in retirement)  expresses who we really are and what is dear to our hearts.

A local group of friends and myself have started an outreach to patients who have difficulty getting around.  Their caretakers must spend time taking them to doctor visits, going to the pharmacy or many other mundane daily activities.  The caretakers, who are saints, are usually other elderly family, friends or neighbors who can only do so much and who, in turn, need to have a break.  Some of the doctor visits are just to have a BP, pulse, and other vital signs on an interim basis until their thorough check-up is due with their primary care physician.  These are easy visits for us since it is something that we do on a daily basis in our practice.  These folks welcome us, enjoy our visit, and feel like it is a social hour.  And you are right - it is a social hour of love and togetherness.  After taking vital signs, the doctor is called and, in 99 % of the time, that is all he wanted to know.  The patient is told to keep his normal appointment and the caretaker is told of the request also.  Actually, the caretaker has an hour off (haircut, personal errands) etc…  The group that I am in consists of active practitioners, nurses, retired docs, other health professionals including one EMT person (who gives one full day/week to this endeavor).  We call it a ministry or an outreach program but it so simple, so necessary, and has just been a joy to be part of it. And guess what? We learn from our visits, gain life experience in our conversations, and get more out of the visit than the shut-ins.  We now have increased our group to include non-professional types for things like drug store errands, haircuts, shopping, lunch, or just a plan visit so that the folks can change the scenery.  Our visitation includes seniors, recovering adults, folks home from the hospital, etc...  "There but for the grace of God, go I."

Next week is Thanksgiving.  Let it be a joy to share your love with family, extended family, and all your loved ones.  And when you are saying Grace at this festive meal, start thinking about how you are giving or going to give back.  I seems to me that this is what Thanksgiving is all about.

I would love to hear from you and share your ideas and experiences.  More Mistakes Made and Lessons Learned next time.

Dr.Donald B. Lurie

donald.lurie@att.net    

Phone:   717-235-0764

Cell:       410-218-2228

Several IRS Tax Court Rulings Dentists Should be Aware of... (if for no other reason than to dispel the myth that the IRS is humorless).

A Bike Sharing Program Isn't Mass Transit

Employee Benefits—Bike Sharing: Expenses an employee incurs by participating in a "bike share program" do not qualify for the favorable tax treatment provided for qualified transportation fringe benefits. According to IRC Sec. 132(a)(5), employers that provide their employees with transportation benefits can exclude those benefits from employees' gross incomes if the benefits are qualified transportation fringes as defined in IRC Sec. 132(f)(1) . A qualified transportation fringe includes any transit pass that entitles a person to transportation on mass transit facilities. A bike share program is not a mass transit facility. Information Letter 2013-0032. 

You Would Imagine They Could Have Thought of a Better Business Purpose...

Travel Expenses for Good Night's Rest: A self-employed tax return preparer that operated out of her home was denied a deduction for travel expenses that were necessary "just to get rest" from the stress of her neighborhood and harassment by clients that called her home at any hour. The Tax Court said that a taxpayer's choice of where to live is personal and her travel to get a good night's rest was a personal, not a business, expense. Meals and entertainment expenses claimed for meals with clients and a catered client party were denied as a business purpose was not established. Joyce Linzy , TC Memo 2013-219 (Tax Ct.).

Bad News for an Independent Contractor Deemed by IRS to be an Employee

Income Tax—SEP Contribution Disallowed: The taxpayer signed a letter of appointment with the British Consulate General (BCG) to serve a three-year term as a trade officer. He was referred to as "self-employed for tax purposes" in the letter and so filed a Schedule C reporting his income and related expenses and took a deduction for a SEP contribution based on his BCG earnings. After finding that the taxpayer was a common law employee of BCG and not self-employed, the Tax Court disallowed his SEP contribution and imposed a 6% excise tax on the excess contribution. On review of that decision, the 9th Circuit agreed that taxpayer was a common law employee. As such, he was not an employer under IRC Sec. 401(c)(4) with respect to his BCG earnings and could not contribute to a SEP and deduct his contributions based on those earnings. Rosenfeld v. Comm. , 112 AFTR 2d 2013-5638 (9th Cir.).

Dental Mentoring Equals Dental Outreach

Here is another guest post from our client, Dr. Donald Lurie.

It seems to me that part of the continuing attempt to refresh and recharge our enjoyment of practice is the chance to be a mentor.  In these times, there is an obvious decrease in the ability to sit back and enjoy the practice of dentistry and medicine.  Interference from many sources,  stress of compliance, making the numbers work are so problematic that the doctor can lose focus on one of the things that brought him into private practice in the first place.  These are indeed difficult times.  The solo practitioner is almost extinct and the mega practices have their own set of problems from a morale standpoint.  

One of the areas that I found to be energizing and helpful was mentoring.  It started with teaching of residents in the early years of practice.  This was a great way to relate and to also keep current.  As all teachers know, you learn more from teaching than as a student.  Not only is it challenging, but it is a great reward to bring the missing link to the "new doc" - experience.  To be in a group and acknowledge an "ah ha" moment is so rewarding.  For those who are fortunate enough to be in a university city with medical and dental students, there is ample opportunity to give (and to relate).  You will find that the student is greatly appreciative that you took the time to help and point the way.  You will also find that you return to the office or to your home with an exhilarating feeling yourself - remember, "it is better to give that receive."  From another view, these contacts become friends, referral sources, and associates that may lead to other projects and outreach possibilities. This is just another example of a means to refresh and recharge.

Knowing how good the feeling is to give a gift to someone, I also had a grand time in mentoring patients of mine.  Actually, my staff also enjoyed it and related to the mission.  There were numerous opportunities where a young patient, entering college, had no idea of his major or area of interest.  This was an opportunity to chat and just become a friend and counselor. We would actually make an appointment in a off time (lunch etc.) to meet and advise.  Did it happen every day?  No, but often enough that we were invited to many graduations (and even some weddings).  I am convinced that we know more than just how to be a good doctor and this ability can be a wonderful way to have that "feel good" day or moment.  So you want to talk about marketing.  This, if done from the heart, is number one in my mind. 

So, it seems to me that you can make some fun out of you practice and have it actually become a source of an outreach program.

I would love to hear from you and share your ideas and experiences.  

More Mistakes Made and Lessons Learned next time.

Dr. Donald B. Lurie

donald.lurie@att.net 

Phone:  717-235-0764

Cell:      410-218-2228