Late in the French Revolution, as Napoleon took over his battered nation’s army, he came to the realization that his opponents were merely unorganized bands of angry mercenaries – thugs who were simply paid money to fight. Napoleon felt his opponents didn’t fight with valor, honor or purpose, so he developed an elaborate system to motivate his own army and give them a strong purpose for fighting. He handed out badges, medals and other awards for acts of heroism and valor because his men were taking risks for their country. Napoleon changed his army from a bunch of pay-for-play brutes into an honorable fighting force. He spoke at length about fighting with a purpose and his army dominated. His army consisted of men who were willing and wanting to fight, and if necessary, die for their country, which was unlike any other fighting force in Europe.

All people want to live their lives with purpose. A purpose-driven life has meaning. It has relevance. Nobody wants to take up space, eat, drink and die. Everybody wants to leave something behind and make their mark.

Professionally, I’ve been pretty lucky, because my dental career has always been filled with purpose. Within six months of opening up my dental practice in 1987 in Phoenix, Arizona, I was utterly demoralized. I had come from Kansas City, where the tooth decay rate in children was so much lower than the population of Phoenix. I could not understand what was going on. Every mouth of every child I saw was ridden with rotting cavities. I was so baffled I called the local office of dental health and talked to what turned out to be the smartest dentist I’ve ever met in my life, Dr. Jack Dillenberg. Jack simply said, “It’s because Phoenix’s water supply isn’t fluoridated.” I told him I felt like I’d be wasting 40 years on an assembly line, drilling, filling and billing for no purpose at all. I wasn’t even going to make a dent in this pile. Jack agreed with me and suggested we start the Arizona Citizens for Better Dental Health and get Phoenix fluoridated. I couldn’t say no. We met every Friday for two years until we convinced the city of Phoenix to add fluoride to its drinking water. I lived all week for that meeting every Friday with Jack because it gave me such amazing professional purpose.

During that time, I’d speak at local schools and teach the children the importance of good home dental practices. My goal was to noticeably improve the overall dental health of my community. It still is. It is my purpose!

Doctor, you are a member of Dentaltown. You read Dentaltown Magazine every month. You are a member of our online community. You join in discussions and passionately argue your case. You lurk around the message boards looking for amazing tips you would never have gotten by attending a seminar. You share cases with your colleagues to find a better way to do a root canal or a sinus lift. You take Dentaltown’s online CE courses not only to get the credits you need but to learn about a new material or technique. Why? Because you have a purpose, too! Maybe you want to be the best cosmetic dentist in your city. Maybe when you were young, your life was changed by a friendly dentist, which made you decide to become part of the profession and pay it back. Maybe you don’t outright know what it is, but since you’re a member of Dentaltown, you’re contributing to your purpose of becoming a better dentist to serve your community better than you would have the day before!

You Are A Public Health Dentist
What’s your purpose, doctor? Think about it! Is it just to improve the smiles of everyone who comes in your door? Are you a self-esteem booster? Is it that you want to improve the functionality of someone’s teeth? Is it that you want to ease the pain of patients whose caries have bored down to the nerve? I read the message boards on Dentaltown.com all day long. I know know there are a lot of people who believe everything needs to be done by free enterprise and that the government is “untrustworthy” and doesn’t trust free enterprise. Here’s the thing… right now in your career, you are a public health dentist. It’s your duty to ensure the dentistry you’re doing is being done faster, easier, of higher quality and at a lower price. And it is your duty to ensure dentistry is available and accessible to everyone. If you don’t do this, then you are proving that the government needs to step in; that’s what happens when free enterprise fails.

If you don’t think you have a professional purpose – make this your purpose!

Go do a Google search on emergency room visits caused by dental problems.What you find might astound you. There is a sickeningly high percentage of ER visits by people who really should be taken care of by a dentist. Why the hell aren’t these people coming to see you?! Do you take insurance? Are you unlisted? When you close your practice at 5 p.m., do you flip on the answering machine? Do you call back?

Make Cost a Purpose
Are you too expensive? You know how when one of your staff members approaches you with the following dilemma, “Um, Dr. Soandso, my friend really needs a root canal and she doesn’t have insurance and she really doesn’t have a lot of money to take care of this, so could you maybe do it for half off?” and you say, “Oh sure, since she’s your friend and you’ve been here 20 years, I’ll do it for half off.”

Really, doc?

Shouldn’t your goal be to treat everyone in your community like they’re your best friend? Shouldn’t all of your root canals be half off? Why should your assistant’s friend get the privilege of paying half off when half of America doesn’t have dental insurance and you’re charging all of them full price?! And why do you raise your prices three, four or five percent every time the Earth revolves around the sun? Why don’t you keep a closer eye on cost and keep your overhead down so you can offer your services to your patients at a lower price?

Once you take your eyes off cost your patients don’t have the freedom to afford the faster, easier, higher in quality, lower in cost dentistry that they deserve. They’ll go somewhere else… like the ER. Furthermore, why would you consider doing an occlusal composite on a six-year-old kid’s #3 when you know amalgam is going to last four times as long and costs you (and the patient) half as much? I understand cosmetic needs, but does anyone really care what the occlusal surface of someone’s molar looks like? Remember, price elasticity tells us that price has a lasting effect on demand. If you sell a Mercedes Benz, very few people can afford it and will pay for it, but if you sell a Chevy, at a much lower price point, everyone will want one and everyone will buy one. Lower your price, increase demand.

Say you’re one of the dentists out there who really loves placing implants – I know a lot of dentists who really do! If you love placing implants, but you keep raising the price every year, you’re going to do fewer and fewer cases. If you really love implants, lower your fee 10 percent and you’ll see more people. Cut your fee in half, and your practice will be swarming with patients.

Give Your Staff A Purpose
I’d say in about half of the offices in America, the dysfunction is palpable enough to cut through with a handpiece. It all stems from the top, doc. The word “doctor” comes from the Latin word “docere” which means “to teach.” Doc, you might be the only one in your practice who went to dental school, but you can’t be the only “teacher” in your practice – you maybe have three operatories but there’s only one of you. You can’t teach to everyone all the time! So delegate your teaching responsibilities. Your hygienists, assistants and front desk staff should be teaching your patients as well. Empower your staff! Great teachers take the incredibly complex and make it so simple to understand that they empower all who listen. Your hygienist knows what’s going on in a patient’s mouth. Your hygienist knows what she sees on the X-ray. She can point out some of the trouble spots to the patient. Give your team members purpose in their jobs. Your receptionist is the front line to your practice, and she should be able to share as much information as she knows with patients and potential patients over the phone.

My assistant, Jan, often tells me about how her job has given her so much meaning and purpose. She fights the good fight to take complex dental knowledge that she has mastered and getting patients to listen to her, because they know if they do they’re going to save their teeth. Then with this knowledge, they’ll go home and start brushing like they were powered by rocket sauce! If they do what Jan says, they’re not going to learn things the hard way by waking up in the middle of the night with a toothache or losing all their teeth. Stop hindering your assistants. Let them teach your patients.

When It’s All Said and Done
When you retire – or, when you die – how will you be remembered by your community? Will you have made an impact? Are you going to be the dentist they say “came to this community 40 years ago when the average six-year-old had three cavities, and now the average six-year-old has four”? How are you going to defend that one when you’re dead, huh?

Wouldn’t you rather people in your community say, “When Dr. Soandso came to this town, he started a denture every day, and when he left he was only starting a denture a month. When Dr. Soandso arrived, kids didn’t floss, now everyone flosses.”

People who trade money for time go home at night and escape with science fiction movies or alcohol or drugs or overeating or something else they need to escape from their dull lives. These are the people who constantly grouse and say they can’t wait until retirement. People who work with purpose die at their desks. Sam Walton, founder of Wal-Mart, was so driven to be the lowest-cost distributor in the world, he worked until he was found dead at his desk. Doctor, it’s time to remember why you got into dentistry in the first place! It’s time to realize or revive your purpose! The people who live and work with a purpose don’t need a 401(k). Know why? Because they’re not the type of people who want to retire.

I’m turning 50 this year, and one of the many things that still amuses me after living a half century on this planet is how a person’s thoughts and ideas evolve – sometimes progressing as we learn new information, other times reverting to old ways of thinking. And it is just as interesting to see how certain points of view change over time. In my first business class at Creighton University in 1980, I learned the return on stocks was about 12.5 percent on average, bonds were about a seven percent return and the ultra-conservative, risk-free government bonds gave you about a five percent return. And if you told me back then that 30 years later bonds would have outperformed stocks, I wouldn’t have believed you. Yet here we are!

While I was in dental school in the ’80s, up to that point in my life I’d never had a cavity. One day, one of my classmates, Dr. Paul O’Malley – who is now, in my opinion, one of the best dentists in Texas – did an exam on me and found eight sticky occlusals on my molars. He did eight amalgam fillings on me the very next day. Then in 1987, when I graduated from dental school, I got caught up in the cosmetic revolution. All of these “gurus” were running around telling anyone who’d listen, “Amalgam expands much more than composite, and that’s why they break all the teeth away. Patients don’t want black metal in their mouths anymore. This new composite material is going to bond the walls together and the tooth will be much stronger than if you used amalgam. Besides, amalgam has mercury and other poison in it.” I was young, got caught up in all the excitement and bought into everything they told me. God knows the patients wanted white fillings. I wanted to believe this beautiful, white filling was so much better than this black, metallic, ugly filling. Everyone wanted to believe it – especially me. A decade ago, I even went so far as to get all eight of my amalgam fillings replaced with pretty composite ones.

I don’t have too many regrets in the last 50 years, but replacing those amalgam fillings with composite fillings is one of them. Every single one of those composites is now a gold inlay or onlay. When those composite fillings failed one by one, I got tired of screwing around with it. I went all gold. If I want something to last the longest, I’ll go gold. But your patients can’t afford gold every time (or ever, in some cases). They’re also tired of coming back to your practice every 10 years or so to get the same tooth fixed and refilled with composite, since you don’t offer amalgam anymore.

It’s time we stopped fooling ourselves. Yes, everyone will continue to ask for composite because it looks good, but it’s time to start informing your patients about the risks and rewards of using a particular filling material. Because aesthetics is valued as much if not more than functionality, if you give a woman the choice between a white composite filling or a dark metallic filling that will last much longer than the white one, she will still choose the white filling 80 to 90 percent of the time. But if it’s a young man who’s starting a family, is extremely busy, barely comes in for scheduled appointments as is, and doesn’t want to keep coming back to get a new filling every 10 years, he might choose the amalgam. And me? Well, I’m a short, fat, bald guy, who, at 50 years old isn’t interested in doing anything cosmetically. This is as good as I’m going to look, gang! I’ll take amalgam any day (in fact I just did… Take a look at the the before-and-after photos on page 18. That’s me last month, baby)!

I’ve had enough of this all-or-nothing, extremist view on dentistry. Are you telling me you can’t place one amalgam in your office? You really think you’re a doctor of dental surgery placing only composite? There are seven billion people on the planet and you don’t see an indication for amalgam in your office? Let’s look at your own six-year-old boy who has an occlusal cavity. Why would you put a tooth-colored filling in there? Is it in the cosmetic zone? Who the hell is going to see it?

The fastest growing segment of the U.S. population is women 100 and older; the second fastest is women 90 to 100. Women are living longer, and coming with it is arthritis, dementia and medications that all but shut down their saliva production. They start getting plagued with root surface decay. So you are going to put in a completely inert composite restoration instead of an amalgam or a glass ionomer? Really? News flash: you can’t call yourself a doctor anymore – you’re an extremist! If you don’t have amalgam in your office – an option that is cheaper, easier, faster and typically lasts longer than composite – then, my friend, you’re an extremist. You can’t call yourself a doctor. You can’t call yourself a scientist. And you think you can call yourself a cosmetic dentist? What, on an 80-year-old lady with Alzheimer’s? Really?

It’s time we take a closer look at amalgam and start offering our patients a choice instead of forcing the cosmetic option down their throats. It’s time the debate took a fact-based turn for the better – for all sides!

This is a very special issue of Dentaltown Magazine. My editorial team and I are proud to present the close-to-definitive Point-Counterpoint debate on amalgam, composite and glass ionomer (see page 82). This process started when I met Dr. Michael Wahl – probably the dental profession’s foremost expert on amalgam. He said he wanted to put a little article together for our readers, which piqued my interest because I had been looking into more information on amalgam at the time. It was kismet, I tell you! There are very few dentists alive today who have done as much research on amalgam as Dr. Wahl, and we are very pleased that he wrote an amazing article for this issue. Dr. Wahl’s first draft was so large, it took him months to pare it down to its most essential points – and it’s still a beast! We also invited two of dentistry’s most outspoken professionals, Drs. David Clark and Lee Ann Brady to present the composite side of this important debate, because there are still some of you out there who have never joined the 21st century and placed composite. And we asked Dr. Umar Haque to discuss the oft overlooked glass ionomer angle. There are indications for all of these materials! It’s time to forego this all-or-nothing crap! It was our team’s goal to be fair, present all sides of the debate and then allow you to make up your own mind and join in on the discussion on the message boards of Dentaltown.com.

It’s amazing what you can find in old closets. I was cleaning out one of mine the other day when I ran across an old, dusty, beaten up Yellow Pages. The fact that it made its way into my closet where it lived for years and not immediately into the nearest trashcan is astounding! I even thought back to 1987 for a couple seconds as I shoved that sallow beast into the Hefty bag. How many of you recall placing expensive ads in the Yellow Pages?

When I graduated from University of Missouri- Kansas City dental school in 1987 the Yellow Pages was a total cash cow. Back then all the “older guys” wouldn’t place an ad in it because they thought it would harm their reputation. So, of course, in Howard Farran fashion, I did it in a huge way and it worked like a winning slot machine for more than a decade! But then every dentist caught on and it eventually started to break even and then lose money. Ten years ago my practice, Today’s Dental, had three full-page ads in three different phone directories. Today we have one small ad in our small local phonebook that covers my neighborhood of Ahwatukee in Phoenix, Arizona.

The slow and steady decline of the Yellow Pages was simply caused by the slow and steady rise of the Internet. And because Mom switched from the stale, static scarcity of limited paper ads in the Yellow Pages to endless Internet search engine results which link to an endless number of Web sites containing information ranging from meet the dentists to blogs on every subject, I now spend $500 a month just on pay-per-click Google ads!

We get so much bang for our buck with online marketing! On the other hand, there are a lot of moving parts with online marketing; things start to add up and it requires a lot of upkeep. You’re not just tweaking the content or the usability of your own Web site anymore – you also have to be mindful of social media, search engine optimization (SEO) and ads on Google; and then throw in all of the tracking that needs to happen to ensure you’re getting a decent return on investment (aka, inquisitive phone calls and new-patient appointments), you’re talking about a full-time job! Unless there’s a member of your staff completely devoted to your online marketing efforts, you’re probably not going to achieve the results you’re hoping for (read: “paying for”). I don’t know about you, gang, but I can’t afford to have one of my assistants or hygienists or even my practice manager spending time updating the practice’s Facebook status – times are tough, we’re a lean crew and we’ve got patients to tend to!

There are a lot of components to juggle and they all channel into the one most important part of online marketing – SEO. Becoming the top practice in a search on Google and Yahoo is the gold medal for every practice’s marketing plan. When someone types in “Ahwatukee dentist” we want our practice to be the first thing potential patients see. It’s what earns you the most new patients – the lifeblood of any dental practice.

The recent recession hit Arizona pretty hard; it was second in state home foreclosures after Nevada, and thousands of Arizonans lost their jobs. The dental industry in Phoenix was hit hard and more than 150 dental practices closed their doors. Some were my very good friends who opened their doors more than 25 years ago like me! But like I’ve written time and time again, when the going gets tough you cut your costs; lower your prices; join a few dental PPOs; add more services to your now smaller patient base like placing implants, using CAD/CAM, treating sleep apnea, incorporating Invisalign; and last but not least, you double or triple your marketing efforts.

The Yellow Pages died in my area, maybe your area is different but I doubt it. You will only know if you track it all meticulously! I went from creating my own dental office Web site in 1999 with my own full-time programmers to now outsourcing it to Sesame Communications because its team did it better than our team could do it internally. Building our B2B (Business to Business) Dentaltown.com Web site was an entirely different set of skills than building a B2C (Business To Consumer) TodaysDental.com Web site. The biggest reason was search engine optimization (SEO). Dentaltown.com does not show up on a Google search because it is a private dental Web site community (which, by the way, recently passed its 150,000th member). We do not want patients doing a search for dental-related questions and answers by trying to become a member of Dentaltown.com. That is not our focus and it’s not why Dentaltown.com exists.

I want patients who live in Phoenix, Arizona, “Googling” dental-related searches to land on my TodaysDental.com Web site, and that is what Sesame did for me in spades! I usually show up first, third and fifth on Google and Yahoo searches. Now my Web site and Google ads are cash cows!

It simply doesn’t make any sense to hire someone to handle our dental office marketing internally. The skill set to understand SEO is far beyond the scope of handing it as a part-time job to any one of my current staff members! People who understand SEO have to do it full time, just to stay on top of it, and all of the good ones earn six figures. I knew this was an outsource play and I needed to find an SEO expert. We needed someone who could be a master of this new, lucrative online marketing tsunami.

You are all likely familiar with my 5 D’s: 1. Design Your Plan; 2. Drop Everything You Don’t Need to Do; 3. Delay Everything You Can’t Drop; 4. Delegate; and 5. Do. This decision, obviously, falls heavily on number four – Delegate.

Since 2008 we’ve been working with Sesame Communications, which has overseen and worked on many of our marketing efforts from Web site development to tracking phone calls. I seriously thought I knew of what we needed to do to increase our SEO and be front and center in Google searches in my area. I was so wrong.

From the get-go my eyes were opened to the myriad components that work together to increase SEO. Did you know you have to have a presence on YouTube? Did you know you need to focus on creating a special mobile Web site for iPhone and Android users? Did you know the fresher your content, the better your SEO? Did you know you really needed your Web site to go live years ago instead of last week (yes, even that impacts SEO)? Did you know posting on Facebook and linking directly back to your Web site impacts SEO as well?

(Speaking of Facebook, I want you to “Like” my three Facebook pages so you can always see what we are posting on…
Today’s Dental: www.facebook.com/todaysdental
Dentaltown: www.facebook.com/dentaltown
And please follow me at www.facebook.com/drhoward to see my daily tips and where I will be lecturing again near you or some place fun in the sun!)

Because of our decision to outsource to a marketing company, we have coherence between our Web site and mobile site, search engine optimization, pay-per-click advertising and a social media strategy, as well as our patient portals and patient engagement tools. On average, we get 148 calls each month from our online presence alone – 41 of those calls can be specifically identified as new patients.

Because 30.43 percent of our prospective patients visit our Today’s Dental Web site before they make their first appointment (as shown by our Sesame analytics dashboard), we decided it was in need of a redesign. Our original Web site had become outdated – and it was merely three years old. With the goal of our site being to get patients to pick up the phone and call our practice, we worked with Sesame, who came to the table with solid research and helped us understand what content needed to be present, and what design elements would keep prospective patients on the site longer. Since we launched the new site in 2011, our bounce rate (the percentage of visitors who enter our site and immediately leave) has decreased from 47.79 percent to 40.52 percent.

And while mobile sites might currently make up a smaller percentage of online activity, it has been suggested that they will exceed desktop browsing in the next three to five years. Think about it, guys! How many of your friends own an iPhone or an Android? Probably everyone! It’s pretty rare to find anyone using a candy bar phone that only makes calls anymore. It’s for this reason we had to develop a mobile site. The mobile site gives patients an optimal view of our site. It reduces image sizes and contains only the information prospective patients need to make a decision, including links to appointment requests and click-to-call functionality. On average, our practice gets 17 calls per month from our mobile site with three of those calls specifically identified as new patients.

One of the key agreements we have with Sesame is improving SEO on popular search engines like Google and Bing. You can’t get to the top of a Google search and just forget about it. It’s a continuous method and it needs to be constantly updated – and every couple of years, the pesky powers that be at Google change up how their engine pulls up information. I’ve learned a good SEO strategy doesn’t just focus on the term “Phoenix dentist,” but also what are called “long tail terms” and terms that aren’t as popular. In September 2011, we decided to focus our efforts on improving our SEO for sleep apnea in Phoenix – and in three months we moved up 66 places.

We’re fairly new at integrating Google AdWords into our marketing plan, but basically when someone types in key words, like “Ahwatukee dentist,” our ad should come up first next to his or her search. Then you set a limit as to what your monthly budget is. The more you spend, the higher up your ad will appear. We spend about $500 a month, but a lot of the effectiveness has to do with how those ads are written. My practice would have a hard time doing it alone, because it is extremely time consuming to come up with new ad ideas and also to track the performance of each ad. You have to keep coming up with fresh content and you have to make sure your staff gets involved.

I was shocked to find out social media has a major impact on SEO as well. Facebook, YouTube and practice blogs all contribute to higher rankings on search engines. We designed our Facebook, YouTube and blog pages to match the look and feel of our Web site. Basically we feed Sesame bits of information about our practice from time to time, which they turn into Facebook posts. We also take 30- to 90-second videos and post them on YouTube, which Sesame optimizes within YouTube.com. Everything connects as well – so when we put a new video up on YouTube, we use Facebook to link to it, and also back to our Web site. Or maybe my associate, Dr. Michael Glass, will post a new blog about sleep apnea, and we will link to it via Facebook and our Web site. In the last five months, we’ve increased our likes on Facebook by 39 percent and we now have 233 percent more patients using Facebook to “check in” at our practice (aka, let all their friends know they’re at Today’s Dental).

(Before you write your next blog you should read our blogs for ideas! I actually think the best dental blogger in America is Alan Mead, DDS, and you should check out his site: MeadFamilyDental.com.) If that’s not enough mind-blowing integration for one practice to worry about – all of our SEO strategies work well into our patient reminder system. Through our practice dashboard, we know 13.3 percent of our patients prefer phone reminders, 4.35 percent prefer SMS text and 86.86 percent prefer e-mail (in which we’ve recently integrated a “refer a friend” button – which, so far, has been used by 13 of our patients). We give all of our patients the option to choose which reminder method they prefer. And all of this automation puts downward pressures on your number-one largest cost, labor!

And when all those calls start coming in, you need to make sure your staff is trained how to close each and every call by getting each one to schedule an appointment. One of the best guys out there to help you with this is Jay Geier and his Scheduling Institute. Jay and his crew just about doubled our close rate of newpatient phone calls. I know this because we can track everything with Sesame’s help.

You know why this sounds like a lot of work? Because it is! If you can manage all of these things yourself, do it! If not, I strongly suggest you work with a company like Sesame that can help you out. These are merely my suggestions to you, and I hope you consider them, that is unless you’d prefer your practice to end up old, dusty and unused in years like the Yellow Pages.

Back before the Renaissance and before Gutenberg’s press, just about everyone farmed. They did everything; raising cattle, chickens, sheep, wheat, corn and potatoes. They made butter and milk and every single farm was the most inefficient operation on the planet. Then people started getting educated, and when people started getting smarter, they started specializing. So rather than focusing on raising cattle and pigs and corn and all the rest of that stuff, they’d modify their entire farm to produce only wheat or whatever would best be produced on their patch of land – and productivity would go through the roof!

Think about health care, now. Even as soon as 1900 you had one doctor doing everything. He delivered your baby. He treated your cysts. He amputated your arm or your leg if you got an infection. He treated your gout. He did everything, and he sucked at all of it. Now look at where we are. In 2000, health care was 14 percent of the GDP, and about half of all practicing physicians are specialized. There is somewhere around 40,000 health journals published monthly around the planet, each one dealing with some specific part of the body or dreadful malady. If you have prostate cancer, you’re not going to see a doctor who treats all different kinds of cancer like breast, liver or pancreatic, you’re going to see a doctor who specifically treats prostate cancer and who has seen thousands of cases of prostate cancer. You’re a dentist. You’re a physician of the mouth. You know that doc who works next door to you who studied ears, noses and throats doesn’t know a single thing about the mouth.

With professions specializing as much as they have – even in the last decade – why are most of you working with a run-of-the-mill Certified Public Accountant (CPA) who literally only has one dentist as a client: you! OK, I’ll try to be fair here; it is likely that your CPA works with one or two other dentists, but you know what that means? Your CPA still doesn’t know a single thing about dental practices. When you’re looking for advice on equipment, purchasing, remodeling or expansion, you’re going to get a crappy, uninformed answer.

In the last 10 years, we’ve seen an evolution in accounting and there are now hundreds of CPAs who are highly specialized and focused solely on the dental profession. Those of you who are on the message boards of Dentaltown.com are likely aware of the most famous one – Tim Lott (tlott@dentalcpas.com). I’m really pleased that Tim is going to be speaking at the 10th Annual Townie Meeting, April 25-28, at The Cosmopolitan of Las Vegas, Nevada. Tim is part of the Institute of Dental CPAs (www.indcpa.org). This group has CPAs across the country who only work for dental practices. You also have another specialized group of dental CPAs called the Academy of Dental CPAs (www.adcpa.org) – founded October 17, 2001, in Scottsdale, Arizona – and they cover just about every geographical area of the United States. One of the larger CPA firms I’m aware of that works solely in dentistry is Cain Watters & Associates, PLLC, out of Dallas, Texas (www.cainwatters.com). For the best interest of yourself and your practice, I suggest you ditch your current know-nothing CPA and hook up with one of these cats.

(As an aside: Maybe your first step should be to ask your CPA how many dentists he/she works with. There’s a small percentage of you already working with a dental CPA, and for that you should be commended! But maybe some of you are working with a CPA who has 50 other dental practices as clients – and at least that guy might get you in the ballpark. I’ll write this again: if you’re the CPA’s only dentist, get out. Then again, if you’re the CPA’s only dentist and only cousin, that’s a bigger problem and I wish you the best of luck over the holidays.)

There are far too many variances between dental practices for a non-dental CPA to be able to give you any reasonable advice. When we look at overhead for dentists there is a huge variance from practice to practice. A solid comparison depends on whether you are in a small, rural farming village of less than 5,000 people in the Midwest or if you’re in a highly saturated urban area like San Francisco or Manhattan. You really can’t compare overhead in a rural area to an urban area. Same thing goes for rent or mortgage. It is so common in rural America for the rent or mortgage on your practice to be one to two percent of sales. It is very common for rent in Manhattan and San Francisco to be seven to 12 percent of sales. Dental CPAs know this. They track the variances and can give you a solid apples-to-apples comparison of your practice to others. And here you are using a CPA who only works with one dentist. You are crazy (maybe not as crazy as someone who isn’t working with a CPA at all, but still… crazy, man).

When you ask dental CPAs, “Should I expand? Should I remodel? Should I add an operatory?” they have spreadsheets and oodles of information at their fingertips that they can use to show you the return on investment, the difference between the return on assets and the return on equity, and how all of it would affect your tax schedules.

Let’s have another look at CAD/CAM. Every single dentist has considered this technology, but what exactly does it do. It lowers your lab bill at the outset, sure, but when you first get it, you might be taking two hours to mill a crown, eating into the time you could be spending with another patient. But then you have to take into consideration, if you keep working with CAD/CAM in your practice, you’re going to get better at it, and what took you two hours to accomplish might only take you one hour in a couple years. By then you’ll be making bank, drastically lowering your overhead and increasing your net income. Your dental CPA can help you make decisions that will positively impact your practice like that. They have the data from all of their dental clients that can aid you in making an informed decision. This is called benchmarking.

Toyota, Honda, Ford, Nissan, Kia and General Motors are all obsessed with what each other are doing. They benchmark each other to death! Benchmarking is done in pro sports and every other industry – even in dentistry. You compete with the guy down the street for your patients’ business. Don’t you want to know how you rate? Don’t you want to know where you excel and where you need to improve? Stop using a general CPA and get with one who is specifically involved with dental practices.

Guys, I see the traffic on Dentaltown.com. I know what you’re into. You really want to learn how to do fillings and crowns and root canals and you’re completely obsessed with the “make something” part of business. You all know you have problems with the “sell something” part and as for the “watch your numbers” part, you’re horrible at it. Usually if I ask a dentist, “Who watches your numbers?” I hear, “Oh, it’s my brother-in-law,” or, “It’s my cousin. He gives me a good deal.” You get what you pay for, gang. Since you’re bad at watching your numbers, you need someone who’s going to hold your hand and help you through it. You need to go to a dental CPA who can sit you down and tell you how your practice rates based on information he’s gleaned from working with hundreds or thousands of other practices.

When you’re working with a dental CPA, they can tell you exactly what you need to do to become more profitable because they can compare your practice to all of the practices with whom they work – successful and non-successful alike. Your dental CPA can tell you if you’re spending way too much on hygiene labor (or not enough), if you’re too high on supplies, if you’re low on assistant labor, if you should purchase CAD/CAM to lower your burgeoning lab bill and how much cash you should be socking away for your future in case you ever feel like it’s time to retire.

It’s time to wake up, gang. We know how much we like making dentistry; it’s what we spent eight years in school for, it’s why we take CE courses to maintain our licenses and improve how we practice, and it’s what gets us out of bed every day. But we all know how much we collectively suck at selling to our patients what we do (that’s another column completely), and we’re fully aware how much we abhor watching our numbers to ensure that what we’re doing is keeping our practices thriving. So if you’re not going to watch your numbers, get someone on your team who will, and make damn sure he or she is as in tune with dentistry as you hope.

I find it extremely amusing how every dentist knows what the politicians on Capitol Hill should do to balance the budget and improve things for the USA. You say they need to cut overhead, scale back entitlements, raise taxes and deregulate. But, here’s what you need to understand: our government is paralyzed. They’ve seen what happens to smart guys who made difficult and calculated decisions that focused more on our long-term sustainability – instead of shortterm, ill-thought-out band-aids – and then lost the next election because of them. The government is not going to do what you know it needs to do to right the ship; the funny thing about all this is while the government isn’t making the tough decisions you know it needs to make, you’re not making any yourself. You all know how difficult it is to do effective dentistry, run a practice, keep paying your mortgage and keep food on the table these days. Do you really even need a reminder about this crappy economy? Here are a few things I see going on in dental practices around the country that make me think some of you need a wake-up call.

Get Your Staff in Gear
When I attend an Arizona Cardinals or Phoenix Suns game with certain dental colleagues who rant and rave about how stupid the team is for keeping certain players on the roster and that they should trade this guy for that guy, I get angry. While they’re going on and on about pro sports, I’m sitting there thinking to myself, “Are you kidding me?! Your receptionist is quite possibly the most slothful human being on the planet and you are fully aware of this, but even after 10 years she still does the same awful job for you, and you let it continue. You really think you can run the Arizona Cardinals? You can’t even run your own practice!”

Why is it some of you have the laziest, most unmotivated, dysfunctional staff in the world, but you hang onto them because of some emotional connection or because they’ve been with you for five years? Guys, listen up, it’s time to make some tough decisions! You need to evaluate your teams. What have they done for you lately?!

It’s tough out there, so it’s time to get tough! Some of you give your staff a dollar raise every time the earth travels around the sun. Your entire pay structure is based on the zodiac. Doctor, if you work hard, you see more money because you’re the dentist and you own the joint. Your bottom line directly correlates with your performance. Your staff doesn’t care if it works hard or not because it keeps getting paid no matter what. They are trading time for cash! It’s time to knock that off. Staff incentives need to be based on production. You need to make the decision and say, “I used to provide a 401(k). I used to provide health insurance. I used to give you a dollar raise every year but I am not doing any of that anymore until our collections reach this dollar amount.” Get your team focused. Give them the same incentives you chase. If the practice does well, then everybody does well. Let your staff know you are only collecting $50,000 a month and until it gets up to $60,000 not a single raise or bonus will be given. That’ll separate the wheat from the chaff pretty damn quick.

Get Personal
I tire of the complaints from doctors who say their practices are failing, but they drive a wicked sports car and live in a high-falootin’ mansion in the ritzy part of town. If this is you, take a good look at yourself in the mirror, doc. Think you made some good decisions? Are you not making tough decisions because you’re afraid how your wife is going to take it when you tell her it’s time to rein in your household spending? Are you afraid of disappointing your oversized ego by downsizing your house and trading in your BMW for a practical car? We hear over and over how important it is to market our practices to get more new patients, and I know a handful of dentists who say they can’t afford to undertake a marketing campaign, yet they lease a Mercedes Benz at $1,000 a month! Are you kidding me?!

Maybe putting your Rolex up for auction on eBay is a good idea. Not just because you’ll pick up a couple thousand dollars but because maybe you’ll start to understand you’re personally spending way too much. I’ll borrow a line from the movie Fight Club: “the things you own end up owning you.” You don’t need the boat. You don’t need the vacation condo. You don’t need the fancy cars. You don’t need a membership to the country club. You can’t afford a stay-athome spouse. You can’t afford to go out to eat four nights a week. You need to sit down and figure out how to cut your personal expenses because they’re also eating into your practice’s bottom line. Seriously, how good does it feel that you bought your wife that Gucci purse? That’s $5,000 that you could have reinvested in your dental practice. You could have bought two or three AMD Lasers for what you dropped on a handbag.

You need to deploy some capital and do some serious investing in your office. I have written about investing in CAD/CAM until my fingers bled. We’ve got continuing education courses about cone beam computed tomography (CBCT) and how nobody wants to go back to using 2D X-rays like a pano or a PA after using 3D CBCT. Why can’t you pull the trigger on these new technologies? Because you – just like your neutered congressmen – feel more comfortable kicking the can down the road another mile hoping things will change. Nothing is going to change until you start making some tough decisions.

Get Marketing
Every time you eat out for $100 that could have been $100 worth of Internet ads on Google or Facebook. My dental practice runs advertising on Google and Facebook and they cost us about a dollar a click. I would rather have 100 clicks to my dental office’s Web site than a fancy dinner. You need higher patient flow, which equals more cash. Every time you are supposed to go out to dinner, go to the grocery store and buy a box of Kraft Mac & Cheese for a dollar instead. Then go home and buy $100 worth of advertising on Facebook. The smaller your market the more effective your ads will be. I live in an area of Phoenix, Arizona, called “Ahwatukee,” and there are 3,600 people on Facebook that have Ahwatukee in their profile. Every time those 3,600 people log onto Facebook they see my ad. Most of the activity on Facebook is from women, and women make about 89 percent of all dental appointments. You can put two and two together…

Get Learning
We have 4,000 periodontists in the United States and every single one of them does a crown lengthening procedure every single day and you don’t even know how to do it? Why don’t you sell your Rolex watch, get on an airplane and fly to some pig jaw course that teaches you how to do crown lengthening especially because insurance pays 80 percent of it. Spend a little of your money wisely on new technologies or CE courses that make you better at dentistry in order to make more profit for yourself and your practice!

Get a Move On
I recently had some long, over-the-phone conversations with two despondent dentists. They are both from a town of 5,000, and the only factory in town – which employed all of the townsfolk – closed down a year ago. The town is drying up and 80 percent of their insured patients were people who worked at that factory. Now those people are not only unemployed but they are leaving the city because there are no job opportunities in town, they have no money and they need to downsize. I listened to these two doctors tell me they were born in that town, married in that town and their kids were born in that town. I told them it was time to make a tough decision. I told them they needed to move, plain and simple. I said, “Look at your ancestors. Damn near every American immigrant made a tough decision 50, 100, 200 years ago when they were sick of living in the country they were in. Maybe they hated the king or the noble landlords. Maybe they were squatter peasants and despised their lives. They knew about the opportunity in America and left everything they had behind. With just the shirts on their backs they took a boat ride for six weeks and landed on the shores of America with nothing (if they survived the journey) just for the mere opportunity for a better life. And you are afraid to leave a ghost town that used to have 5,000 people and move an hour away or to a different state for better economic stability?”

Get ’em Out of Your Pocketbook
Another thing I hear all the time that continues to bother me is dentists telling me they are about to literally go broke by putting their kids through college. Here’s what I say, “Doctor, did your dad pay for college? He didn’t? OK, does your son in college even have a job? No? Does he have an iPad and an iPhone? Does he have a credit card? Are you paying his car insurance? Why don’t you do your son a favor and tell him after this semester he is on his own. I was on my own, I made it, and I was a better person for it!” I would put all of my eggs in the basket of a self-made man any day over some daddy-did-it who was born with a silver spoon in his mouth.

Some of you have heard of the Five Ds. Design your plan. What do you have to do? What is your tough decision? Number two, drop everything that doesn’t matter. This isn’t the time to be in the Kiwanis Club, guys. This isn’t the time to be coaching your kids’ little league team. Get focused back on your business! Let’s delay everything we can’t drop. Let’s delegate everything that can be delegated so you can do your plan. Guys, the feather in your cap is this – unlike your government, you don’t have an election to worry about every four years. You can make the tough decisions to ensure your personal and professional success. Stop trying to make nice with everyone and start acting like a boss. If you and your practice fail because you didn’t make the tough decisions, do you think they’re going to help you out? No, because your staff is now out of a job and hates you for letting the practice tank; you were your family’s bringer of bacon, and they know nothing but “spend.” It’s time to end this craziness. The buck starts and stops with you.

I’d love to hear from those of you who were recently faced with making a tough decision – whether in your practice or on the home front – and I want to know what the outcome was. Send me an e-mail at howard@dentaltown.com, or post your tough decision on the message boards of Dentaltown.com or in the comments section under this article on Dentaltown.com.

Ten years ago, Dentaltown.com was a feisty upstart online community that was ever so slowly gaining traction with dentists and dental professionals around the world. It was really beginning to take shape and it was getting stronger with every passing day. New members were finding out about the Web site from current members, signing on and starting discussions most dental professionals never had with their peers ever before. There was no fear; on Dentaltown.com, none of us were competing against each other for patients in the same area, and it was nice to finally be able to discuss our own practices with our friends and stop feeling so alone. Ten years ago, we were all just getting to know each other online, and the positive conversations and the help that we were all giving to one another were leading to some true friendships!

If I wasn’t working away at my own dental practice here in Phoenix, Arizona, I was working on Dentaltown.com with my team, to ensure it remained an impactful and viable online community. Back then, I was putting in 80+ hour work weeks. It was all I could do to even get a full night of shuteye. But, man, we were having a blast meeting new dentists from around the world, connecting them with dental manufacturers and service providers and turning this fledgling Web site into the strongest and largest online dental community the world had ever seen!

Then, out of the blue, two Townies (aka, members of Dentaltown.com) from opposite coastlines of the United States – Dr. Sameer “socalsam” Puri and Dr. Tarun “T-bone” Agarwal – came to me and told me the members really wanted a place to be able to meet each other in person, and that they wanted to help make that happen. I thought it was an awesome idea; I thought how cool it would be just to see all of these dental professionals get up from their computers, hop on a flight and come together in one room and meet each other for the first time – even though they’d known each other online for months, or even years. That idea formed the first-ever Townie Meeting in Las Vegas, Nevada. We all expected the first meeting would draw maybe 100-200 people and it drew more than 450 attendees! Due to the hard work of Sameer, Tarun, volunteers like Dr. Glenn Hanf and our partners over the last 10 years it’s only gotten bigger and better. We turned this annual event – part dental meeting, part family reunion – into the best dental event in the world. I really can’t believe how far we’ve come.

This April, we are celebrating 10 years of the Townie Meeting and I’m personally inviting every single one of you to come and party with us. It’s going to be a blast! This meeting isn’t just for members of Dentaltown – as always, all dental professionals are invited! This year, as in every year, we’re heading back to Las Vegas. Why Vegas again? The American Dental Association surveys its members every so often and asks them where they’d like to have the annual session. The overwhelming response is Vegas. It’s America’s Playground, baby! It has more flights, more hotel rooms and more offsite activities than anywhere else in the United States. So keeping the Townie Meeting in Vegas every year makes it one of the easiest destination events for dentists around the United States.

This year, the Townie Meeting is going to be held at one of the hottest and newest hotels in Vegas – The Cosmopolitan. You’ve got to see this place to believe it. It’s breathtaking. It’s such an appropriate setting to celebrate a decade of the Townie Meeting. For the last 10 years Sameer and Tarun have listened to attendees, by reviewing evaluations and responding to comments about previous seminars and every year the presentation line-up just gets better and better and better. We’ve got an incredible line-up of speakers this year. I’m pleased to share the stage with the Madow brothers (on loving dentistry, having fun and prospering), Dr. Michael “Miguel” Melkers (on communication and comprehensive care), Dr. Frank Lauciello (on removable prosthetics), Tim Ives (on curing caries), Dr. Mike Barr (on Web site SEO), Dr. Dan Poticny (on CEREC), Dr. Uday Reebye (offering a hands-on bone grafting workshop with pig jaws) and so many more.

You really should try to arrive on or before Wednesday, April 25, so you can take part in some fun pre-Townie-Meeting activities with me and the rest of your pals. The Townie Golf Extravaganza tees off at 1 p.m. on April 25, so bring your clubs! To learn more about fees and schedules, visit www.towniemeeting.com. Later that evening, we’re holding the Wine & Cheese Welcome Reception from 6 to 8 p.m. It’s a nice, low-key time to reconnect with old friends, hang out with me, Sam and T-bone, mingle with some of the awesome speakers who are going to be presenting at the meeting, and it gives you the opportunity to pick up your meeting credentials early (so you can avoid the lines and have more fun).

Each year, the opening party (the highlight of the meeting) has a special theme. In years past we’ve had the Townie Prom, Townies in Space and an ‘80s theme. Who can forget the Toga party at Caesars Palace a few years back? This year, the party’s on Thursday, April 26 and (drumroll, please) our theme is James Bond. Come dressed up as a villain (Jaws, anyone?) or a Bond girl – or even as 007 himself. Last year we saw some great costumes and this year we hope everyone brings their A-game! I would be remiss if I didn’t mention the Fifth Annual Townie Texas Hold’em Poker Tournament, which starts at 12:30 p.m. on Friday, April 27 in the exhibit hall (have you ever seen a poker tourney on a dental show floor before?). These poker games are pretty amazing and all the players have a great time (even when they’re losing, but especially when they’re winning).

I want to thank Sam and T-bone for having the guts and vision 10 years ago to take a risk and create this meeting for all dental professionals to enjoy. Join us as we celebrate 10 years of the Townie Meeting at the Cosmopolitan in Las Vegas. I truly think that if you’ve never been to a Townie Meeting before, you will find it is unlike any other dental meeting you’ve ever seen. Go check out www.towniemeeting.com and learn more about what else we have in store for you. See you in Vegas!

 

After one of my recent lectures, I was shooting the breeze with a few doctors and we got on the topic of retiring in this putrid economy. One of the docs said, “Y’know guys, I went to a funeral the other day and I thought about that phrase, ‘Nobody on their death bed ever says they wish they would have spent more time in the office.’” This elicited some hearty chuckles, but I thought, “Are you freaking kidding me? That’s exactly the opposite of what every meaningful person ever said on their deathbed.”

I mean, do you think Mother Teresa would have said, “Man, I wish I didn’t spend so much time working in the orphanage. I wish I didn’t take so much time caring for the sick and the dying, and raising money for my mission of hope,” on her deathbed? Most spiritual leaders say the way to serve God is to serve your fellow man, and the more you serve your fellow man, the more you serve God. Guys, you’re health-care providers! You’re not out there selling something someone doesn’t need. When you’re doing dentistry faster, easier, higher in quality, lower in price, you’re serving your fellow man. You need to stop thinking about when you retire, and think more about how you can better serve your patients!

OK, spirituality aside, you’re all aware by now that we’re in the middle of an economic contraction. Things aren’t looking too good. In fact, things aren’t going to look any better until we have at least one balanced budget. It bothers me when economic Neanderthals constantly claim the U.S. economy is growing one-and-a-half to three percent a year when the national debt is more than $15 billion. Things need to get worse before they get better. When I was a freshman in 1980, interest rates were around 21 percent. If we endure another round of inflation, a 21 percent interest rate will probably be the absolute minimum (which if you have an adjustable rate loan with floating interest, you’d better tie that sucker down ASAP). And you’re thinking about retirement? Guys, here’s the bottom line: It’s time for an attitude adjustment.

One of the ideas you have to get rid of is you’re not going to retire at 55. You’re probably not going to retire at 60, or even at 65. But even more – why would you want to?! The most fun and exciting people I meet when I go out and lecture are dentists who are 70 years old and they’re still going strong; they still love what they’re doing. Sure they might have cut back from five days to three or four days a week – but they’re still really into dentistry. The days they do work, they make a hell of a lot more money than they would on the interest of their retirement savings account. When you’ve been a dentist that long, you know just about all there is about your patients’ mouths. You’re pumping money into your 401(k) in hopes to retire by 60, but that’s working against you. Seriously. Yes, it’s pre-tax savings, but right now we’re seeing the lowest tax rates in 100 years, and it’s a certainty that when you pull the money out in 10 or 20 years, the tax rates will be twice as high. A 401(k) doesn’t make sense.

You need to find a way to keep working and the way to do that is to keep enjoying what you do. Look at Sam Walton, the founder of Wal-Mart and Sam’s Club. He found a way to sell all of the big brand names like Sony and Hitachi and Coca-Cola with a low-cost distribution model. He had multiple myeloma at the end of his life. Instead of lying around feeling sick, he’d fly from his office in Bentonville, Arkansas, to Houston, Texas, to get his chemotherapy treatments, and then fly back to Bentonville to continue working. The man died a billionaire – and he died at his desk doing what he enjoyed doing. He saw his work as a mission.

Another attitude you’re going to have to beat is running your practice the way you’ve always run it. In this great contraction you need to have lower prices. You’re going to have to increase your marketing and add new products and services.

Every time the Earth goes around the sun, you give your staff another dollar-an-hour raise, and you end up raising your prices five percent. You have to knock that off. In this contraction, you need to freeze wages, and maybe the next time our planet goes around the sun, you’re going to have to lower your prices five percent. This means you might even have to go back and join dental insurance plans. People are going to buy only what they really need or really want to buy. If they can’t get their dental work taken care of with some supplemental insurance help, they might not do it (they’ll even shop their treatment plan around to other dental practices and go with the cheapest office).

Marketing-wise, if you don’t have an awesome Web site by now, you’re not even trying – hell, you’re not even paying attention. You should be search-engine optimized so you show up on the first page of Google results, you should be buying Google ads, you should have a Facebook page, and you should be buying Facebook ads.

You should be adding new products and services. Get a 3D CBCT machine and start placing single root form implants. Go to an orthodontics course and learn how to do simple ortho. Learn Invisalign. There’s a bunch of sleep dentistry groups that treat sleep apnea and snoring. Go sign up to make all the mouthguards for your high school football team. Do something!

It’s also important you start lowering your costs. So, quit doing gold. If an insurance company is only going to give you $1,000 for a crown, you can’t afford a $250 gold bill for a full gold crown. This is challenging to people because they believe in phrases like, “Treat other people like you want to be treated.” I have seven restorations in my mouth and they’re all gold. But I can’t do that for all of my patients. I’m not getting a raise from the insurance company and the price of gold has doubled. I can’t do full gold. Neither can you. So instead of a lab bill, invest in CAD/CAM technology.

Right now, I feel really bad for people who work in the luxury business. The sales of Fairline yachts, Cadillacs, Porsches, high-end steak dinners, Louis Vuitton purses and Barker Black shoes are going to plummet. You’re even going to see the profits of midlevel restaurants like Chili’s and Olive Garden shrink while the profits of Taco Bell and McDonalds grow (a $5 lunch looks better than a $15 lunch to just about anyone these days).

That being said, I live in Phoenix, Arizona – one of the most saturated markets in dentistry – and I could give you the names of almost 100 dental offices in my backyard that have gone under. They were part of two groups. One group was the high-end, cosmetic, metalfree practice that would replace all your fillings with tooth-colored restorations. They dealt in bleaching and veneers – and now they’re gone. They quit doing bread-and-butter dentistry like root canals and crowns; they didn’t know how to make a denture, they didn’t pull teeth, they couldn’t dig out a wisdom tooth, they couldn’t do minor orthodontics. Everything was elective, and patients elected to do something about their yellow, crooked teeth some other time.

The other group of practices that went under was start-ups. Start-ups went under because new-patient flow is down coast-to-coast. Even practices that are flat or growing five or seven percent every year are still facing low new-patient flow. It used to be you’d open a practice, do some marketing, buy an ad in the Yellow Pages, do some targeted direct mail and you’d fill your office up with patients. That’s not working anymore. Practices that have been around for 15-20 years and have good word-of-mouth referrals, solid reputations and high marketing budgets are going to take most of the patients in the area.

This contraction isn’t letting up any time soon, gang. It’s time we all realized we’re in this for the long haul and we need to remember to return to our core competencies, stop thinking about retiring at 55 or 65 and make it a point in this new year to lower your costs, increase your marketing, add something new to your dental armamentarium and lower your fees.