Athena Consulting: Dental Practice Solutions

Back in the 1960s, Illinois Sen. Everett Dirksen was appalled by the spiraling federal budget. “A billion dollars here and a billion dollars there,” the eloquent curmudgeon intoned in his booming baritone, “and pretty soon you're talking about real money!”

A new dental-school graduate dreaming of starting a practice probably isn’t thinking in the billions. But still, when a young man or woman emerges from a college life marked by scraping together pocket change for food and entertainment and suddenly is confronted by price tags with lots of numbers to the left of the decimal point, the sticker shock sets in fast and hard.

Oh, the things they don’t teach you in dental school.

You may have graduated near the top of your class. You may have the most complex chair-side procedures down pat. You may be dazzled by visions of your name on a building and your smiling face on a brochure.

But then come the financial realities, one after another.

You have the student loans – sometimes from parents – to pay off. You have the new responsibilities of living on your own, or as a new spouse and maybe a new parent.

Then there’s your chosen profession. You could land a position as an associate at a chain dental center, but those spots are hard to come by, especially with no experience outside school. You’ve gotten a lot of encouragement to build for your future by starting your own practice, but when you start adding up the initial costs – finding a location, designing your space, building and equipping it, marketing it, staffing it – the mind boggles.

So it’s time to visit a bank – but which one? Why would banks want to invest in you? Can you write a business plan that will win them over? How large a loan will you require, knowing that even after your practice opens you’ll need cash flow for day-to-day operations until the schedule fills with patients?

Do you understand demographics – the current and projected population of the area in which you want to practice, its age distribution and income level – and how those numbers will affect the price you’ll pay to lease a high-visibility space, the way you’ll market it and the conduct of your day-to-day operation? How many other dentists already are in business in that area, and do you have the time and resources to find out? What is the ratio of dentists per population that would constitute market saturation?

Have you thought about the digital radiography that today’s dental consumers expect? Its total cost could top $100,000 once you figure in the panoramic machine, the space for it, and the computers and software to run it. That’s a big chunk, but have you considered how many thousands in revenue you’d lose every month if you didn’t have the pano – as well as the risk of a malpractice suit or state board action if you miss something the panoramic x-ray could have revealed?

The price of high-tech endodontic equipment is also high, but not having it means you’ll have to refer patients to a specialist – again, a significant loss of monthly income for you.

Were you taught how to make sound economic choices regarding architecture, décor, cabinetry, chairs, handpieces and infection control? Where will you advertise for competent chair-side assistants, hygienists and other staffers, how much will you pay them, and how will you train and motivate them to become an efficient, harmonious team?

You’ll now be using computers for much more than e-mails, word processing and downloading music. Do you know what software you’ll need to run a HIPAA-compliant paperless office, with maximum efficiency in scheduling, billing and charting?

Who will design your logo and branding? Who will design a sign that can draw all eyes to your office most effectively but also meet the city’s and landlord’s rules? How much will it cost for an attractive web site, and to design, print and mail thousands of brochures? What’s the right place – and the wrong place – to advertise, and what will that cost?

How long did they spend teaching you about the complexities of insurance and collections?

You could avoid some of the initial set-up expense by buying an existing practice, but most of them must be updated at substantial cost to meet today’s standards. There’s no guarantee of patient retention, and good buys are hard to come by in the first place because only about 4 percent of dentists are retirement funded and end up working until they’re no longer physically able to.

And speaking of retirement, what about yours? Are you skilled at proper financial planning and budgeting which will give you some viable choices once you reach your fifties?

All those financial concerns land, one after another, like extra straws on the back of an already overloaded camel. That’s because you also face clinical challenges that weren’t an issue in the rarefied atmosphere of college.

As a student, you might have had cooperative test patients, with a wise older professor/doctor at your side to instruct and advise. No more. Now you have difficult patients, difficult staffers, difficult choices.

You were trained in dental jargon, not in the down-to-earth language patients understand – and you realize the difference the first time you try to explain a procedure and get a blank stare in return.

Were you trained in the strategies needed to gain patient acceptance and staff respect? You’ve got all the hand skills now, but how are your people skills?

If anything in the preceding paragraphs has caused you to exclaim, “Gee, I hadn’t thought of that,” then an alarming thought may soon follow: “Uh oh. If I didn’t know some of these vitally important things, then what else don’t I know?”

You can fill some of those knowledge gaps with continuing-education courses, lectures and voracious reading. But you as the practice owner are still responsible for getting it all done. Will you have any energy left to do what you do best – dentistry?

With all this on your plate, the last thing you should be doing is reinventing the wheel.

A full-service dental consultant may well be the answer – one that doesn’t just pile more reading material in your “in” basket but that listens to your needs and goals and then walks you safely through all the minefields of starting and operating a successful practice.

Employing a consultant who is that thorough, however, is pricey in itself. Again, the sticker-shock monster raises its ugly head. The only way to slay that monster is to realize that mistakes made through trial and error would be even more costly – as well as how much extra revenue your practice will generate each month if you have time-tested guidance from experts.

The business world isn’t an easy place. Every initial investment you make in a new-start practice comes with a natural wince. To turn that wince into a confident smile requires learning something else dental school didn’t spend much time teaching you: cost-benefit analysis and the power of your own goals and ambitions.

As Sen. Dirksen said, “There is no force so powerful as an idea whose time has come.”