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.