Monday, September 29, 2014

Finding an Associate Dentist Job - It's not Just What You Do, It is How You Do It

Here is another guest blog from our friend Morgan Pace at ETS Dental.
Dentistry is a highly technical field requiring extensive training to hone clinical techniques and skills, yet it is often not these technical skills that determine who get the best jobs after dental school. Generally, the “soft skills” are what will make or break your chances of landing an ideal associate position. To separate yourself from other associate candidates, it is important to recognize what these skills are and why they matter.
What are “Soft Skills?” Soft skills, or people skills, are what inspire trust from patients. They make someone an effective communicator and a productive part of a team. There are many soft skills needed to be an effective dentist, but here are the leading soft skills requested by the practice owners for whom we consult.

Communication skills

Patients will take it for granted that the “Dr.” in front of your name means that you are qualified to drill a tooth or seat a crown. They do not become long-term patients because your margins are perfect. They come back to you because you are a pleasant person who understands your patient’s apprehension and takes the time to answer his or her questions. When interviewing a potential associate, a practice owner will look for these characteristics to determine the quality of your communication skills:

  • Clear articulation: Can you convey ideas so that others easily understand?
  • Expressiveness: Do you use voice inflection and descriptive language to avoid sounding “dry?"
  • Empathy: Do you inspire trust by accurately reading the emotions of others and respond appropriately?
  • Confidence: Do you exude self-assurance in your abilities?

Attitude and Outlook
Practice owners need their associates to be an asset to their practice. Most genuinely want the associate arrangement to be a “win-win” arrangement where everyone profits. Hiring a clinically exceptional but emotionally-taxing associate will not be sustainably beneficial to the practice. To avoid this, practice owners will look for the following:
  • Positive Attitude: Are you generally optimistic or are you overly critical? Will it be fun to work with you?
  • Willingness to learn: Are you accepting of feedback and helpful criticism or do you become defensive?
  • Flexibility: Can you adapt to changing circumstances and new challenges?
  • Work ethic: Will you exceed the minimum expectations? Will you go above and beyond for your patients when necessary?
  • Motivation: Will you continuously strive for improvement? Do you set challenging personal and professional goals? Will you be satisfied if you fail to achieve those goals?

Even the freshest new dental school graduate is a doctor and so has earned the respect of the dental practice staff and the larger community. With this respect comes the demand of maintaining a professional demeanor. Beyond that, you are a highly compensated professional with a public profile. You are a pillar of the community who will be a leader in the office. Can a practice owner trust you to maintain this esteem? Here is what he or she will look for:
  • Time Management: Can you be trusted to be ready to see patients as soon as the practice opens?
  • Team Player: Will you be cooperative and respectful when working toward greater group goals?
  • Leadership: Will you lead the office staff by example? Will you avoid petty squabbles? Will you have the courage to address problems and work towards solutions?
  • Problem Solving: Will you apply your training in a creative manner to drive innovation and improvement?
  • Work under pressure: Can you be trusted to maintain decorum under deadlines and through difficulties?
The more of these skills you display, the more comfortable a practice owner will be in choosing you for his or her practice. Remember - it is not what a practice can do for you, it is what you can do for a practice. 

Posted by Morgan Pace, Vice President and Senior Dentist Recruitment Consultant with ETS Dental. To find out more, call Morgan at (540) 491-9102 or email at

Friday, September 26, 2014

The 9 Dos and Don'ts of Divorcing Your Business Partner

This is a guest blog from Melanie Glickson, ESQ.

            The dissolution of a business can be just as harrowing as divorcing your spouse.  Business partners split up for any number of reasons.  Sometimes one partner is not producing.  This might be due to personal troubles, like addiction to drugs or alcohol, which leads a breakdown in the business relationship.  Sometimes one partner becomes embroiled in an inappropriate romantic relationship with an employee, or otherwise engages in unprofessional behavior that places the practice at risk.  Sometimes financial wrongdoing (or perceived financial wrongdoing) is involved.  And from time to time, partners split up with each other simply because they have gotten on each other’s nerves over the years, with minor resentments building to excessive levels – again, not unlike many marriages. 

            If you find yourself in a situation where you feel you need to divorce your business partner, consider the following “dos” and “don’ts” to mitigate the cost and the stress associated with dissolution.

            1.         DO consult with a business attorney once you decide to ditch your partner.

            It can be challenging to effectuate a dissolution: you want to keep it quick and simple – all the while paying attention to the details. Add to this, managing the emotional and interpersonal stress associated with the separation.  Consult with a business attorney early.  You will be so glad you did.  A good business lawyer can help you clarify the steps to wind up the business and dissolve.  She should also be able to advise you about restructuring the business after dissolution - if you want to continue with the business afterwards.   If things become contentious, a litigator will probably need to get involved.  On the other hand, if you read, understand and act on the advice in this article, it might not have come to that.  While it is prudent to seek advice and counsel from an attorney at the beginning of the process, in most cases actually involving the court system should be seen as a last resort

            Each state has its own procedures for terminating a business entity, depending on the type of entity (LLC, corporation, general partnership, etc.).  The partnership agreement or operating agreement controls these terms, but if there is no agreement, or the agreement does not address dissolution, then the default rules provided in the state statute apply.  There are rules pertaining to voluntary dissolution (where the members consent) as well as court-ordered dissolution.  For voluntary dissolution, these procedures are not complicated, but there are certain necessary steps that need to be followed depending on the state and the type of entity.  For example, in Maryland, an LLC’s creditors must be provided with 19 days’ advance notice of dissolution.  You can consult your state’s business database to learn more about these procedures.

            2.         DO have an agreement in place that addresses dissolution.

            A good partnership agreement or operating agreement will address dissolution, like a prenuptial agreement in a marriage.  While not required by law, it can be risky to conduct business without one.  The agreement can provide a set of steps to end the relationship and repurchase the interest of a partner who is not performing or is unsatisfactory for reasons the agreement provides (i.e., conviction of a crime, loss of license, sleeping with the receptionist, a burgeoning addiction to mouthwash, or any other specified conduct). 

      If you never had an agreement with your partner, or if your agreement does not address dissolution, try to negotiate the terms of dissolution together with your partner.  Your attorney will memorialize these terms into a formal agreement in which you and your partner release each other from any claim relating to dissolution.

      If you are unsure about whether you want to separate with your partner, but you do not have any agreement governing your business relationship, have one drafted immediately.  While it’s better to draft these agreements in the beginning of the business relationship, it is never too late, until it is too late.  Simply advise your partner that you heard horror stories about practices that had no agreement, or say you are trying to boost the level of professionalism of the practice in general.

3.   DO elicit assistance from third-parties.

      Rather than arguing with your partner back and forth or losing sleep over the details of dissolution, utilize third-parties who are well-versed in issues surrounding dissolutions, and who can look at the situation without emotion.  Examples include attorneys, accountants, appraisers and mediators.  As an example, don’t tear your hair out trying to determine a range of value for the business – consult with your accountant.    

      If you are unable to come to mutually agreeable terms with your partner regarding dissolution, a neutral third-party in the form of a private mediator can cut short legal fees and resolve the matter quickly.  Parties typically fail to take advantage of mediation early enough, and could have saved significant legal fees and stress had they chosen to mediate early in the dispute.  Mediation sessions can often be scheduled at the last minute with a mediator that is mutually agreeable to both sides.  Many mediators are retired judges.  They are very knowledgeable and experienced at defusing tension and arriving at a settlement.  Your attorney can fill you in on the background of the potential mediators.  The mediator is paid an hourly rate that the parties often agree to split, or to count as a business expense associated with winding up.  The mediator puts the parties in different rooms with his or her attorney and goes back and forth to discuss the matter privately with each party to try to resolve the dispute.  Unlike arbitration, which is binding according to what the arbitrator decides, mediation yields a resolution only if the parties agree.  Mediation is confidential and the communications that take place cannot be used in litigation, in the event the case does not resolve and the parties move forward with a suit.

      If you are unable to negotiate the terms of dissolution directly or through a mediator, or through counsel, the dissolution will need to occur through the court system.  This should be seen as a last resort, as it is costly, public, and often involves mudslinging by both parties.

4.   DO review leases, contracts, and loan agreements to see how dissolution will affect them.

      Before you discuss a business divorce with your partner, you should review any leases, loan agreements, and contracts to determine the impact of dissolution.  Often, the business is still bound by the contract or lease through the end of the contract period or lease period, regardless of dissolution.  Sometimes you can negotiate with your landlord, but these are all subjects you need to discuss with your partner.  You should approach your partner about dissolution having reviewed these documents in advance.

5.   DO try to be direct and communicate with your partner about separating as soon as you decide.

      Once you decide to separate from your partner, sit down with your partner and have an honest, direct discussion.  Be tactful but truthful.  Allow time for the news to sink in and then address the details. 

      The break-up discussion is difficult, but important to conduct.  Consider the following example of how complicated things can get, very quickly, in a business breakup when the lines of communication are not left open.  One particular individual decided to break up with her partner.  She was so worried about her partner’s reaction that she never actually sat down and communicated her desire to separate.  Instead, over a weekend, she unilaterally moved half of the office property into storage and transferred half of the money out of the bank accounts.  On Monday morning, the partner walked into the office to find half of the furniture gone, half of the money gone from the accounts, and a letter on her desk announcing the split, asking for consent to dissolve, and threatening to seek judicial dissolution of the business if she did not give consent.  The surprised partner called the police and tried to have her partner arrested for embezzlement.  Then, she (the surprised partner) hired a lawyer who threatened to file a temporary restraining order against the unilateral-acting partner, preventing her from earning any income until she returned the office furniture and the money.  Both parties threatened to file breach of fiduciary duty claims against each other.  Both the tension and the attorney’s fees escalated at breakneck speed. 

      6.  DON’T communicate directly with your partner once lawyers are involved.

            While open, honest, direct communication is key at the beginning stages of a dissolution, if the split becomes acrimonious, both sides need to communicate only through counsel.  It is not unusual for the attorneys to pass along telephone messages and mail on behalf of their client, to the other business partner, so that the parties do not have to communicate directly.  While this may seem unnecessary and juvenile, for various reasons, adverse parties should not be communicating except through counsel.  Moreover, if the relationship has truly devolved, even communications about ordinary office banalities while the parties are still in business together can lead to knock-down, drag out arguments.

            7.         DON’T allow personal feelings to draw out the process.

            At the end of the day, you don’t want to wind up in a situation where you are paying your lawyers large sums to fight about who gets the copier and who gets the office chairs.  Just like when a marriage ends, distribution of the assets can be wrought with the emotion over the breakup.  Don’t succumb.  Tell your attorney what you are willing to compromise about and let her do the negotiating.  You can give your attorney the authority to negotiate on your behalf without necessarily giving you a detailed play-by-play of every detail and every discussion.  You, not your lawyer, will have ultimate approval authority over any agreement proposed.  Take a step back, and don’t get lost in the details. 

            8.         DON’T lose sight of the bigger picture.

            When you are negotiating the terms of dissolution with your partner, whether it is directly, through counsel, or through mediation, keep in mind that it is usually worth it to give up something in exchange for peace of mind.  Orient your frame of mind on your next chapter.

            9.         DON’T overthink it. 

            You should give careful consideration to the prospect of separating from your business partner, but don’t obsess.  As painful as it can be to split with your partner, if your gut tells you it’s necessary, you will probably be better off in the long run.  People torture themselves for years wondering “should I, or shouldn’t I?”  It’s better to act quickly and move forward toward the goal of achieving business success.

 For more information about your particular situation, contact Melanie Glickson, ESQ.

Tuesday, September 9, 2014

IRS Pays Taxpayer's Legal Bills - Tax Court Ruling

Chalk one up for the taxpayers.

Penalties—Taxpayer Awarded Attorneys' Fees after IRS Refuses to Abate Incorrect Assessment: A taxpayer, whose son lived with him most of the year, claimed Head of Household (HOH) filing status but did not claim his son as a dependent. (He and the child's mother had agreed that she could claim the dependency exemption.) The IRS issued a math error notice to the taxpayer, indicating that it had changed his filing status to single because the name of the dependent who qualified him for HOH status was not reported on the return. The taxpayer made a timely request for abatement and included the reasons for claiming HOH status. During a collection due process hearing, the IRS refused to abate the assessed tax, despite the taxpayer's support for filing as HOH (e.g., name and Social Security of his son). Upon filing a petition with the Tax Court, the IRS conceded to abate the assessment. The taxpayer requested reimbursement for his attorney's fees under IRC Sec. 7430(a), which the IRS challenged. The Court sided with the taxpayer because the taxpayer was the prevailing party, exhausted all administrative remedies available to him within the IRS, and did not unreasonably delay the proceedings. Michael Swiggart , TC Memo 2014-172 (Tax Ct.). 

Monday, July 21, 2014

IRS Phone Scam Alert

Our friends at Rea and Associates recently featured an article in their newsletter that sparked a lot of internal conversations here. One of our senior folks had received one of these phone calls (as had some of our clients). Rea and Associates kindly allowed us to share this with you as well.

Here is what Lance Jacob, EA has to say about his experience with one of these scam calls:

1.       The callers had foreign accents (not that there is anything wrong with that)
2.       They made it seem like they are working with a supervisor and will transfer your call when you start asking questions (the only mistake was that he transferred my call and I could tell it was the same person I had just spoken to).
3.       The area code was 202 making you think they were calling from IRS headquarters in DC

4.       Ask them for their badge number and a callback number because you want to speak with the IRS Taxpayer Advocate and call them back. They will probably hang up.

Be On Guard For IRS Phone Scams

Maribeth Wright | July 17th, 2014

You get a call from a man who said he was from the IRS and was informing you that criminal activity was found after the IRS performed an audit on your past taxes. Then he asks if you had a criminal lawyer to represent you. And as you tried to get a word in edgewise, he told you not to interrupt him because the IRS and local authorities were recording your phone call. Pretty unnerving, right?

Well, unfortunately, this phone call actually took place with a client. And these types of phone calls are happening constantly. Back in April, the IRS issued a warning for consumers about phone scams targeting taxpayers. During the 2013 tax filing season numerous phone scams occurred, but the IRS has seen an increase in these scams since then. Because the IRS believes that these incidents will continue to plague taxpayers, it’s important to be vigilant for these kinds of calls.

The 4-1-1 On These IRS Phone Scams

  • Some taxpayers who received these calls were told they’re entitled to a big tax refund, or that they owe a lot of money to the IRS that needs to be paid immediately. Don’t be fooled. The IRS won’t contact you via phone about these matters. If you ever owe the IRS money, you’ll be sent a written notification via mail.
  • The IRS will never ask you for personal financial information over the phone, such as your credit or debit card information. If you’re asked for this information from someone claiming they’re from the IRS, don’t give it and report the incident immediately to the IRS.
  • Some IRS scammers use fake names/surnames (most of the time these names are common) and IRS badge numbers when they identify themselves.
  • It’s possible that a scammer knows and can tell you the last four digits of your Social Security number.
  • The phone number that a scammer calls you from could look like it’s from the IRS toll-free number.
  • If you take one of these scam calls, you may receive a bogus follow-up email to make it look like it is a legitimate inquiry from the IRS.
  • You may be threatened with jail time or driver’s license suspension from one of these scammers. They may then hang up on you and then call back pretending to be the police or DMV, further trying to prove their claim to you.

What Should You Do If You Get One Of These Calls?

So have you received one of these calls? If so, and you’re not sure the next step, here’s what you should do:
  • If you think you might owe taxes or there may be an issue with your taxes, call the IRS at 1.800.829.1040. Someone at the line can help you determine if you indeed have a payment due.
  • If you feel you received this call unexpectedly and know you have no IRS issues, call and report the incident to the Treasury Inspector General for Tax Administration at 1.800.366.4484.
In light of these increasing incidents, be on the lookout and don’t fall prey to these scams. Hang up if you’re uncomfortable with the call. And know that the IRS would never ask for personal financial information over the phone or in an email. If you receive any suspicious emails, forward the email

Ohio Tax Help

If you’re ever unsure about anything you received from the IRS, whether it be a letter, a phone call or email, contact Rea & Associates. Our team of Ohio tax professionals can help you determine if the inquiry is legitimate, and assist you with responding.

Author: Maribeth Wright, CPA (Cambridge office)

Thursday, July 3, 2014

Why Become a Dentist?

Here is another guest post from Dr. Donald Lurie.

It seems to me that goals and aspirations upon entering dentistry have changed drastically over the years.  A few weeks ago, I was attending a conference and the subject arose as to "Why did you become a dentist?"  I thought this was a really easy question until I tried to write down the reasons that I entered this wonderful profession 50 years ago.  As I reflected upon the question, I realized that the dynamic had changed so dramatically over the years that it was now, for me, a most difficult question to answer and to update.  

I listed the reasons that started me on this journey:  to heal and to cure the sick, to maintain independence and be my "own boss", to have the ability to make a substantial income, to provide for my family, to obtain respect in the community were but a few of the immediate reasons for charting this path.  But now the dynamic has changed so much that I am not sure that I could compare those thoughts to a new student with aspirations.  You would have to interpret the ability to be "your own boss". I am not sure that, in these times, that is as possible as in the "old" days.  The time of solo practice, of studying, training, postgraduate degrees and residency and then entering practice on your own appear to be over.  

I remember going to the bank and asking for a loan to open my own office.  The banker (a classmate from college) advised me as to what he thought it would take, shook my hand and said there would be some paperwork to fill out.  He suggested that I go and find my location, lease the property and prepare to renovate the space for my needs.  He also suggested that I bring the information back to him so he could advise me.  Thus, with the help of my accountant who was already on my team----before I even had an office---the Team of Retirement (which I have talked about in earlier articles) was started.  This is actually a philosophical term of practice management that has served me well. It has served me well.  Can you imagine being able to do that in today's financial world?  And would you have the fortitude (guts) to do it.  In those early days, this was the norm.  There were very few group practices, especially in general dentistry.  Some of the specialty practices had small groups but there were fewer specialists in total.  I suspect that this was a means to keep the "market closed".  As time went on, more specialists opened on their own and over the years, many of them merged; and many of them dissolved.

The desire to heal the sick and to make people well and return them to function has never dissipated.  This is still a goal that has been with me my entire life and even in retirement I continue to give and to donate effort to this ideal.  However, I wonder if the freedom to exercise this is as easy as it was in my beginning.  There is so much litigation, so much inspection, so many bureaus to satisfy, that I wonder if I would have the courage to try some of the new techniques and projections that I did in those days.  If a doctor had an idea, he would suggest it to a patient and many times, it was accepted and tried.  Now I am not talking about moribund procedures, but rather a new technique or variation on a theme mixed with good common sense and based on good surgical knowledge and experience. And if the "experiment" went wrong, the social media that is now present would crucify me and the good that I had done over the course of my years in practice might disintegrate quickly.  These are just thoughts but it gives me pause as I look back on reasons why I became and Dentist and Oral Surgeon.  

I think that the opportunity to make a good income and to provide for one's family is still viable but I am not sure that it is as attractive as it once was possible.  The tax laws are so different and the age of insurance and government interference have also changed the dynamic.  The large groups are doing quite well and are able to diversify but the small solo practitioner may be another story.  I have to yield to the accountants for introspection on this, but it is something that I have heard many times recently. 

I mentioned above about the respect of the community and I think that is still true.  The doctors of today are TALL and WELL REGARDED.  I think that this has always been so and it is a tribute to the schools and to the profession that has nurtured us on our journey.  We feel discomfort when one of our group is challenged or if a bad report hits the news since we feel it reflects on all of us.  It is part of our heritage that we want to "do no harm."  I also feel that (especially in these times) our brothers and sisters do a fantastic job of carrying on the respect of the professions. 

And so I think that you can understand how difficult it was to list and compare the reasons that started me in this profession of dentistry and surgery.  The years of training were many (including dental and medical school and then residency), but they are even longer now.  I would challenge you to sit and reflect on your career and for the reasons that you are where you are at this time.  Reflect, meditate and make it better while you can.  And may this wonderful career bring peace and joy to you and to those you serve. 

We are all here to help one another.  Please do not hesitate to send me you thoughts, questions  or comments.  It would be an honor to help.  

Dr. Donald B. Lurie
Phone:     717-235-0764
Cell:         410-218-2228

Friday, June 20, 2014

Is a Letter of Intent (LOI) Necessary When Buying or Selling a Dental Practice?

Here is a repost from Tim Lott, CPA, CVA and Ellen Dorner of NL Transitions, a Dental Brokerage firm.

The easy answer is no, it is not necessarily needed.   In most states it is not a legally binding agreement anyway, so why go through the effort?

There are actually some very good reasons why having a LOI is crucial to every dental practice transaction, in spite of it not always being a legally binding agreement.  In my opinion, there really is no downside to having one.  Let’s discuss what a letter of intent is and what purposes it serves.

The primary purpose of the letter of intent is just as it’s titled, to lay out what one’s intent is as it relates to the transaction at hand. It should be a one or two page letter or memo detailing some of the major points of the transaction. In the case of a sale or purchase of a dental practice, some of these major points typically identify: what’s being purchased, the parties involved, the price, the timing of the payment, the structure of the transaction, exclusions, covenant details, seller’s compensation and general terms, buyer contingencies, time frames for acceptance of offer and due diligence, deposit requirements, etc.

As mentioned above, since the majority of these letters are NOT necessarily legally binding and may be somewhat boiler-plate, they shouldn’t cost too much in the way of professional fees to put one together. While you may not need to have an attorney involved to draft and submit a letter of intent, we do suggest you have attorney look over it before submitting it to the other party. If you can hammer out the meat of the transaction BEFORE engaging your attorney you may save money and a lot of headaches having your attorneys iron out these issues.

The letter should be a way for the parties to document what they believe has been discussed as it pertains to the major points. It serves as a way to let the seller know your intent to purchase the dental practice is serious enough to make a written offer and should give them some level of confidence that you’ll be committed to the transaction.

It is customary for the seller to require a deposit with the signed letter of intent. The amounts can vary, however, it’s usually in the range of $5,000. Many times the deposit is non-refundable so if the buyer walks away from the transaction, the seller is covered for any professional fees they’ve incurred to entertain the offer. If a seller requires a substantial deposit then the seller may also have to commit to a penalty if they walk away.

The drawback of NOT having a LOI is that without consensus on the main points, the two parties can wind up going back and forth, or worse, the attorneys or other professionals go back and forth on the main points and the parties wind up spending more in professional fees than they have to. Do yourself a favor and minimize your stress level, start with a LOI BEFORE jumping right to the legal agreements. 

For more information about your situation, email Ellen Dorner or call her at (800) 772-1065. Visit our website at .

Tuesday, June 3, 2014

Tax Court Rules that Horse Racing Losses Can Be Deducted

Here is one of those instances where meticulous record keeping paid off.

Income Tax—Horse Racing Activity Not Passive: The Section 469 Passive Activity Loss (PAL) rules limit losses from any trade or business in which the taxpayer does not materially participate. The Tax Court has recently held that a lawyer's losses from a side thoroughbred horse breeding and racing activity (thoroughbred activity) were not PALs and consequently were currently deductible. The lawyer presented a narrative summary (prepared using telephone records, credit card invoices, and other contemporaneous materials) at trial demonstrating for the three years at issue he had participated in the activity for more than 500 hours during each year. Stefan A. Tolin , TC Memo 2014-65 (Tax Ct.). 

For a review of you particular situation, contact us, in addition to specializing in dental accounting, we are widely respected for our equestrian accounting skills. (800) 772-1065

Monday, June 2, 2014

There’s More to Selling Your Dental Practice Than the Price

Here is a post from Tim Lott, CPA, CVA and Ellen Dorner of NL Transitions, a Dental Brokerage firm.

Far too many times when dentists are preparing to sell their dental practice, they are focused mainly on the price and may wind up overlooking many other issues surrounding the practice sale that are just as important, some even more important than the price. That is not to say the price is NOT important, because it is; however, there are so many other aspects of the transaction.  Sometimes you need to know when to give on one issue so you can profit or benefit from another issue.

The following are some examples of different components of the dental practice sale where the seller can benefit.

How are you handling the assets that you are including in the sale? How is the price going to be allocated among those assets?

o As a seller, do you know how the allocation is going to impact the income tax picture in the year of the sale?  It is important to have an income tax projection done to determine how one allocation may differ from another in terms of the income taxes you will pay.  If there’s an allocation that works better for you, compromising on the price may be necessary for you to benefit from that allocation.

If you plan to stay and work for the buyer as an associate, how will you be compensated?

o Would you prefer to be treated as an employee or an independent contractor? What professional expenses do you want the new owner to cover?  These are all negotiable points and if you’re planning on staying on for at least a year, the compensation you receive might actually be more valuable to you then standing firm on a higher price.

Will you be selling the accounts receivables to the buyer in addition to other dental practice assets?

o If so, how will they be valued?  If you’ve compromised on the price of the other assets, you might be in a better position to use that as your negotiating chip for a more favorable price on the accounts receivables.

Do you currently own the real estate where your dental practice is located and if so, will you be selling it or renting to the new owner?

o Again, if you’ve compromised in other areas of the transaction, you’ll want to remind the buyer of the compromises you’ve made in those areas so the price of the real estate or monthly rent works more in your favor. The annual increases and/or expenses can be passed through to the buyer within the lease agreement.

So as you can see, there so many other areas that get negotiated during a practice sale.  If you are solely focused on the price of the practice, you may wind up losing a good buyer when, in actuality, the difference in the price may be made up in other areas of the transaction.  It is important to look at the ENTIRE picture and plan accordingly.

Have a range in mind for the price you’ll accept for the practice.  Also have a range that you’ll accept as compensation, a range for the value of the receivables and if you own the real estate, a range for the sales price or annual rent.  When you approach the transaction with a global view instead of just concentrating on the price, you’ll have a much better chance of success in not only selling the practice, but getting what you want from the ENTIRE package.

For more information about your situation, email Ellen Dorner or call her at (800) 772-1065. Visit our website at .

Monday, May 12, 2014

The Conversation a Dentist Can Have with Fearful Patients

Here is another post, the last in a series, from our friend Jen Butler of Jen Butler Coaching.
It doesn’t matter if patients react from flight or fight mode.  Both types can be easy to work with and does not need to make for a stressful day at the office.
These steps will help you connect, defuse, and gain case acceptance.
  1. Empathy- “Mr. X, you seem uneasy/unnerved. In my experience those patients are often the ones that are the most uncomfortable coming to the dentist.  How are you doing with this?” Here’s where you are going to hear, “I don’t like the dentist.”  Hard to hear as a dental professional and also NOT TRUE. Realize when a patient says, “I hate the dentist,” they aren’t talking about you.  This isn’t personal so why are you having a personal reaction? They don’t know you so how can they not like you?!  They are reflecting back on past experiences with other dentists.  This is fantastic information for you to connect with and turn this patient into a real patient for life.
  2. Validation- “Mr. X, many patients like yourself share with me they don’t like going to the dentist.  I’ve learned over the years that it’s not the dentist they don’t like but the fear of having cavities, needing work, or experiencing pain that they are looking to avoid.  Would that be true for you?”  If yes, “I see.  That’s totally normal and we are here to work with you through this process.”  If no, “Then what about going to the dentist has you so uneasy/unnerved?”  Validation is the most powerful means of connecting with your patients.  It says you get them and you know how to meet their needs.  FYI- that’s priceless, tangible value for a consumer and they are willing to pay for that.
  3. Clarify-  Find out what the patient knows about their previous treatment and diagnoses.  Sometimes you’ll find the patient has thoughts that are not accurate which is feeding into their irrational fear.  You can help them understand and calm their nerves by using Empowering Questions.  Examples:  “What do you know about this treatment?” “What do you remember about the diagnoses?”  “When you recall the conversation, what words pop out most for you?”
  4. Fill in the gaps- When a patient recalls something with misinformation or not as you remember, don’t have an emotional reaction about it.  Chalk it up to basic functions of the brain.  It takes at least 3 times for anyone to retain new information accurately.  You are going to fill in the gaps for patients about treatment, payments, insurance, procedures, processes and systems.  It’s not them.  It’s not you.  It’s ALL OF US.  You can either have those three times be at three different appointments or all three times built into one appointment.  That choice is yours.
  5. Offer solutions minus the fear-  Patients want treatment, even the fearful.  No one innately wants to have bad oral health.  Help them accept treatment by asking this important question, “If we can do something that will [blank] AND it will be pain free, will you do it?”   The power in this question is the AND.  Don’t forget the AND.
  6. Offer a way out- Here is where you talk about the difference between pain and discomfort.  Not much in dentistry really hurts.  There is a lot in dentistry that is uncomfortable.  Laying with your mouth open, people poking at your gums, the notion of someone drilling into your teeth..don’t tell me that doesn’t sound uncomfortable.  It doesn’t cause pain.  Give your patients different words to think about as you proceed, questions to ask themselves during procedures, and a definite way out.  Consider saying, “As we move forward I want you to ask yourself, ‘Is this causing me pain or am I in discomfort?  If it hurts, we will stop and figure out why.  Nothing we are doing today should hurt.  If you are in discomfort we have lots of ways to make you feel more comfortable.  I just need to know the difference.  Regardless, there is always a way out.  You are in control of how fast we go and what we accomplish today.”
For more specific advice on your particular situation, email Jen or call her at (623) 776-6715

Thursday, May 1, 2014

What Should a Dentist Do When a Patient Wants to Flee?

Here is another post, the second in a series, from our friend Jen Butler of Jen Butler Coaching.
Patients that come from a place of fight are easier to pinpoint, not easier to work with.  The body has a defense mechanism that when put in dangerous, threatening, or fearful situations gets louder, bigger, and more aggressive to ward off what we perceive as a dangerous predator- yes, meaning you.  I know what you’re thinking, “Patients chose to come in.  I don’t force anyone.”  Doesn’t change the reaction they have.  Remember, this is biology and physiology that is so automatic to our systems we don’t even recognize when we are in these modes.  Patients are not choosing their reaction and they are not making a conscious decision to make your life and the team’s lives miserable.
Patients that have the fight response look and sound like this:
  • Move loudly throughout the office, making sure everyone knows they are there.
  • Direct responses, often being borderline rude or curt (they are on the offensive).
  • Appear grumpy and negative.  I refer to them as prickly- like a porcupine with it’s quills out.
  • Easily jump into conflict and disagreements with anyone in the office. “Mr. X, isn’t this weather wonderful?”  “What’s so wonderful about it.  It’s so sunny out it’s blinding me!”
  • Use sentence enhancers (swearing), exclamations (Darn it, ‘You’ve got to be kidding me’, etc) and name calling to deflect anyone from noticing their real feelings.
Patients with the fight response are more challenging to navigate through than their counterparts.  Patients in fight mode can be scary, uncomfortable, and mean.  It’s normal to walk away from an experience with a fight patient and need to decompress and regain your composure.  You might want to go as far as dismissing them from the practice altogether.  These are the kind of patients that take you to the brink of, “This isn’t worth it,” and walk away from everything you’ve created.
There is a way for you to: 1) not be affected by these types of patients; 2) assure them they are in a safe place; 3) have a mutually positive experience.  Start with these steps:
  1. Accept the patient’s reaction.  You won’t be able to change their automatic response.  You can change their experience.  Control what you can and influence the rest.
  2. Don’t come from ego.  This isn’t about you or your team.  The patient didn’t wake up in the morning and purposefully set out to ruin your day.  They are afraid.  If this were a child afraid what reaction would you have?  Why is it different because it’s an adult?Fears are irrational no matter the age.
  3. Slow down and give space.  Being in fight mode comes with intense emotions and high energy.  Don’t fuel the experience further by talking fast, rushing the appointment to get through it, and matching high energy.  Slow the experience down by talking just a bit slower, move with more intention, sit lower than your patient with rounded shoulders and your hands in your lap (just until the fear has dissipated), and hang back just a few extra inches when you can to give some space.  Balance your patients energy, don’t fuel it.
  4. Ask empowering questions to get the patient talking.  The more you know about them and connect, the greater the chance they will be able to share with you what’s really happening.  If they already knew how to tell you they were afraid they would have.  Help them along by asking the right questions.
  5. Be honest, upfront and just ask.  If you find the patient’s fear is really getting the best of them and it is derailing the experience, be honest and just ask, “Mr. X, I’m wondering if you are nervous about being here?”  Wait and listen.
For more specific advice on your particular situation, email Jen or call her at (623) 776-6715

Monday, April 21, 2014

What a Dentist Should Do When a Patient is Fearful

Here is a guest blog post from our friend Jen Butler, M.Ed., CPC, BCC from Jen Butler Coaching.
Fear and dentistry seem to go hand in hand.  Whether the fear comes from childhood experiences or is solely psychological, fear is a real thing that patients often bring with them to their appointments.
Here’s what most dentists and their teams fail to remember: people have two biological, automatic reactions when dealing with fear, FLIGHT or FIGHT.
Those patients that are in flight mode often look and sound like this:
  • Sound, they don’t make sounds, not even when asked questions. They are struggling internally to keep it together.  They also know the more conversation had during their experience, the longer they will be there.  Their goal is to get out!
  • Often show a nervous twitch by moving their feet, bouncing their leg, moving their hands, etc.
  • Ask, “How much longer?” or “What’s next?” or even “Are you almost done?”  They can’t wait to get to the door and RUN.
  • Avoid talking about same day treatment, say they want to schedule another appointment and then don’t schedule.
Flight patients are harder to notice because they are stealthy.  Meaning, they don’t let on that they are afraid.  These patients leave you wondering ‘what’s wrong with them’ or ‘with you’ because their appointment was like pulling teeth, and not the literal kind.  You can’t help but reflect on how awkward their appointment was for you and the team.
To effectively work with people in flight mode:
  1. Know the signs.  You and your team need to be able to recognize patients in flight mode.
  2. Offer calming methods to reduce fear and stress (music, laughter, warm blankets, dim lighting, stress balls, show comedies, etc) if you think they are a flight patient.
  3. Be assertive and ask, “I’m curious Mr. X.  How nervous are you about being here today?” The problem addressed is the problem solved.  Until the fear is addressed, the patient can’t truly listen and take in what you are saying about their oral care.
  4. Demonstrate confidence in your clinical skills. So often when a patient isn’t giving off the right vibe dental teams back away, feeling awkward and it throws them off their game.  They start second guessing their movements and begin to put further psychological stress on themselves which makes everything even more uncomfortable.  Know that your training and experience has uniquely prepared you for this moment with this patient.  You know how to connect, offer painless procedures, and provide a comfortable, caring environment.  Trust in that and move on.
  5. Don’t reinforce stress by talking badly about the patient, ever.  It’s normal to want to vent or release the stress of working with a fearful patient to your team.  DON’T!  The more you talk about how awkward it is to work with that patient, or how much they squirm and jump while you blow air on their teeth, or even when they don’t say two words to you the more you reinforce to you and others that it was a negative experience.  Find another way to release your stress like breathing, positive self-talk, or take a 5 minute break.  What you tell yourself you believe so be careful of what you think.
Flight patients are experiencing something very real.  As a dental professional, you want to learn how to navigate through working with this type of patient because it will make  your job and that of your team much easier.  Plus you will have less stress!
Contact Jen Butler, M.Ed., CPC, BCC at (623) 776-6715 and visit her website at Jen Butler Coaching

Wednesday, April 16, 2014

Is a Traditional Practice or a Group Practice Right for a Dentist?

Here is another guest post from our friend Carl Guthrie at ETS Dental.

Twenty years ago, the vast majority of dentists were solo practitioners who called their own shots and ran their own businesses. Today, group practices represent a significant percentage of the market and now provide an alternative to traditional solo practice. At this point in your career, which setting is right for you?

We have placed hundreds of dentists in both group and traditional settings. While walking a job seeker through the decision process, we consistently hear the same set of "pros and cons" offered for both settings. Here is an overview that we hope will prove helpful to any dentist considering a new position.

There are many types of group practices. For the purposes of this blog I will define traditional practices as those that have a sole practitioner or two partner doctors. Group practices include corporate groups, offices run by practice management companies, and private practices with three or more doctors.

Traditional Practice:


  • More income potential as a practice owner or partner
  • Freedom to run the office as you see fit
  • Freedom to pursue your own clinical interests
  • Equity position is more likely

  • Cons:

  • Complete responsibility for the practice
  • Many hours of administrative work outside of clinical hours
  • Balancing clinical CE with business development training
  • Practice growth is your responsibility

Group Practice:


  • Limited or no administrative responsibilities
  • Limited or no time required outside of office hours
  • Reduced overhead could improve compensation
  • Collegial setting
  • Larger marketing budget
  • Ability to specialize within practice
  • Mentors available – clinical and business
  • CE program in place
  • Ability to negotiate higher fees from insurance companies
  • More funds for equipment and technological upgrades
  • More common to find benefits packages include group health insurance, 401K, and more

  • Cons:

  • Less clinical autonomy
  • Less or no control on business of the practice
  • More colleagues to disagree with
  • Quality of colleagues work reflects on you
  • Less freedom to pursue niche
  • Equity position less likely
  • Higher staff turnover
This is certainly not a complete list of all the varying aspects of these two settings.

Contact Carl Guthrie with any questions you may have.

Tuesday, April 8, 2014

The Value of a Second Opinion to a Dentist

Here is another thoughtful blog from our esteemed client Dr. Don Lurie.

It seems to me that every health care professional sometimes needs to take the same advice that he gives to his patients.  "I suggest that we get a second opinion on this…"

I have written many articles regarding the beginning of our practices and continuing to retirement.  As I have said, (The Profession of Retirement, May, 2013) the new career of retirement requires planning and thought including the obvious financial requirements  and also the emotional preparation (Emotional Preparation for Retirement, March 21, 2014).  I strongly believe that preparing for retirement should start with the onset of our practices and that careful management by the proper team of advisors is essential to accomplish this.  Like with most things, we get into a routine and things just continue to function and run - timely donations to retirement funds, investments, insurance, etc... 

However, I made the mistake and took it all for granted.  Things and circumstances do change.  Health can be a factor in your planning (or lack of same), personal goals, motivations, insurance needs and many other components that combine to make our new career of retirement frightening and foreboding.  It is my hope that you can learn from my mistakes and make this transition so more calming and smooth.  I think the key word here is "transition". 

About 10 years before I retired (after 50 years), my "CEO" who really was my accountant (and the head of the Team of Retirement, August, 2013), suggested that we examine several areas of my life and practice.  He also suggested that we get a second opinion on various subjects that incorporate the business of dentistry and oral surgery.  Did we have an accurate appraisal of the worth of the practice or were we hiding our head in the sand? Do we still need to continue large amounts of life insurance or can we scale back as the age increases and other investments take over? Do we have a team in place to advise us on how to Transition the practice, think about buyers, target the buyers, bring in an associate/buyer etc? Are the investments good for the short term (while in practice) or do we need to start looking for a different quality of investment or moderate style of investment for those retirement years so that there can be some inner peace without the volatility of "the gamble"? I thought that my accountant was really so wise to suggest second opinions and it proved to me that he was the correct person for the job of CEO by being unafraid to show and share our information to an unbiased group of advisors.  It is with this vision that I was able to make even better decisions, long before retirement, to make this retirement career seamless as the time approached.  Of course, the first 6 months were an adjustment but I was ready for them.  And after that period, my life has taken on a new purpose and joy that I could only hope would be the case for everyone.   Another big area that needed a second opinion was the role of the corporate attorney.  Were our documents in order? So a review of the articles of incorporation was carried out at that time.  This also helped me in finding the attorney that I thought would be the right person at the time of transition.  This was invaluable and helped to keep that stomach-ache at a minimum.  It was just one worry that was eliminated knowing that there was the right person to turn to at the given time. Another area in transition to be considered is insurance.  Do you have the right kind of life insurance, enough or too much, malpractice insurance (enough or too much), real estate insurance if it applies and are there other insurances that your situation requires? What about HIPPA? Do you have the right IT person to help you to transition? Does he need to install systems at home to help in the transition? The list of questions goes on. 

I always made it a rule when I was in active practice, that I would not be the treating surgeon after I gave a second opinion.  I made this clear to the patient initially and reinforced it.  This gave me clearance to be more objective and to sincerely want to help both the treating doctor and the patient in solving the problem or conflict.  I followed this rule when I receive my second opinion from the outside group of advisors.  They were helpful and, more importantly, reinforced my admiration for my lead accountant.  Both groups agreed that I needed a specialist in practice transition to get to where I needed to go. 

The detail of this team was amazing including instructions to staff on what to say to the patients, how to explain what was going on, where charts would be available, etc.  Actually scripts were written so that there would be consistency among the staff when answering questions.  I cannot emphasize enough the value of scripts.  They should be used throughout your entire career

So I would urge you to reevaluate your situation, get that second opinion and move on, either with your original team or perhaps with the new advisors.  It may be an amazing discovery.  The goal is to make this as smooth a process as possible but you too must have an open mind and be clear about your goals.  They should be written down. Keeping a journal is a valuable tool.  Remember, "You cannot live a positive life with a negative mind."

The Team of Retirement for me was key.  Outside advisors and specialists were brought in at various stages of my career and for their efforts, I am eternally grateful.

These are just some thoughts that were on my mind regarding practice transitions and the possibility of a need for second opinion.  We are all here to help one another.  Please do not hesitate to send me you thoughts and questions.  It would be an honor to help.

More Mistakes Made and Lessons Learned next time.

Dr. Donald B. Lurie
Phone:     717-235-0764

Cell:         410-218-2228