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11th Annual Mega’Gen International Symposium – New York, NY

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For more information on seeing Howard speak at this event:

11th Annual Mega’Gen International Symposium
267-291-1150
http://vizstara-professional.cdeworld.com/events/130

5/1/2015
New York, New York

Grand Hyatt Hotel
109 E. 42nd Street
New York, NY 10017

MegaGen jpg

Dr. Farran’s Seminar Coordinator is:
Rebecca Parent
rebecca@farranmedia.com

Debt and Cash Flow

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by Howard Farran, DDS, MBA, Publisher, Dentaltown Magazine

There is not a billionaire on earth who doesn’t use debt to benefit business. Even if you started saving money the day you were born and never spent a penny, you’d die before you’d ever see your bank account reach a billion dollars. Billionaires borrow other people’s money (OPM), whether through stock or bond offerings or a bank. They buy or build something and then they pay back the loan.

You could have worked a minimum wage job for 40 years, saved money and paid for dental school in cash. But instead most of us took out student loans. You may not be a billionaire, but you used OPM to build your career. This was smart debt.

The same goes for purchasing equipment in the practice. The adage “you have to spend money to make money” is true, and it often entails other people’s money to get to that point. This isn’t to say you should blindly go into massive debt. Analyze the ROI on a piece of equipment. What will the benefit be to your practice and how long will it take to pay back the loan?

It’s a privilege to borrow

It’s a privilege to be able to borrow money. Third world countries don’t have this option. Debt is leverage, but it’s treated as an emotional decision.

I graduated from dental school in 1987 with $87,000 in student loans. That’s in the $220,000 range today. I paid it back after graduation while working as a dentist because the lowest-paid dentists made $50 an hour. That’s 10 times what I would have made working and saving money at that minimum wage job. If I hear one more dental school graduate whine about his $300,000 in student loans, I’m going to slap him! Those loans took him from earning $5 an hour to $50+ an hour

I often hear dentists say they don’t want to purchase a CAD/ CAM or CBCT unit because they don’t want to go into that kind of debt. You have to look at a number of other factors besides the sticker price of a piece of equipment like that. What will having your own CAD/CAM unit do to your lab bill? If you’re doing more crown and bridge work and slashing your lab bill in half, how long will it actually take you to pay the loan off? Does the technology attract more new patients because of same-day appointments? Does adding a CBCT unit mean you can start performing more complex implant procedures in your practice?

Work with a dental CPA

Work with a dental CPA to see if a big purchase is a good move. When I say dental CPA, I mean a CPA who works exclusively with those in the dental profession, not a CPA who has one or two dental clients. To find one, check out: The Academy of Dental CPAs (ADCPA.org) and The Institute of Dental CPAs (INDCPA.org). These professionals specialize in dentistry and can help you to best determine if a purchase will be beneficial to your individual practice.

Look at the reports that matter

There are three main reports when you’re looking at your practice finances: the statement of cash flow (Fig. 1), the balance sheet (Fig. 2) and the statement of income (Fig. 3). They’ll all reflect debt differently.

Your statement of income (P&L) shows numbers like depreciation, deferred taxes, etc. It’s mostly used for tax purposes.

Your balance sheet is only used when you’re trying to get a loan. It’s not used to make business decisions. Debt will always make your balance sheet look ugly. The statement of cash flow is what actually matters. This statement is what really shows what’s happening in a business. As humans, we tend to be emotionally connected to the debt on a balance sheet.

But your statement of cash flow can be solvent. It’s what makes leverage out of debt, and debt is what separates the billionaires.

The data provided in the Financial Statements is based on an average from the clients of Naden/Lean, LLC. These reports were provided by Tim Lott who is a partner with Naden/Lean, LLC, a professional services and CPA firm with a specific concentration in the dental industry. He has been working with dental professional for thirty years and w e appreciate his contribution. Timothy D. Lott, CPA, CV A; Naden/ Lean, LLC; tlott@dentalcpas.com; (410) 453-5500 Local; ( 800) 772-1065 National; www.dentalcpas.com

In memory of Dr. Rou’aa Diab

Dr. Rou’aa Diab, a female dentist, was arrested by the Islamic State on August 22, 2014. She was arrested with four others in Al-Mayadeen, a city on the border of Iraq. Without proper trial, Diab was charged with the crime of “treating male patients,” and was executed.
As fellow dentists, Dr. Diab was a colleague to each of us. She was beheaded for helping prevent and treat dental disease. She should be recognized for her bravery and dedication. And her name should never be forgotten.

See more at: http://www.dentaltown.com/Dentaltown/Article.aspx?i=372&aid=5079#sthash.OfKFTcgi.dpuf

How to Successfully Integrate CAD/CAM

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I had active Townie Dr. Sameer Puri come to my practice to train my staff on a new CAD/CAM software last month. Why? Because I wanted my assistants to know how to use the system just as well, if not better, than I do. I know that 90 percent of the questions asked by patients are fielded by the front desk and the assistants, not me or the other doctors. And because of this, I want all my staff to know what they’re doing!

So many doctors go to CE courses or conferences alone. They’ll do in-office training alone. They’ll never teach their staff the software or systems or procedures. This doesn’t make any sense. You don’t work alone. You don’t run your practice alone. Why would you attend a conference to learn how to better your practice and then not bring your staff along? That just doesn’t make sense.

I sat down with Sam to ask him about CAD/CAM implementation. Our office has it already, but not all offices do. I wanted to see what he had to say about the technology and how he helps doctors successfully implement the machine into their offices. Here are some of his tips:

Train Your Team

The key with any office utilizing CAD/CAM is getting your team on board. At one point, there was a lot of debate about whether the technology worked or was worth it. I think that’s over. There have been offices—single doctor, one assistant, one front desk—that have been successful and there have been multi-doctor, multi-staff offices that have integrated it efficiently.

Once you get your team trained with how to use CAD/CAM properly, the dentist really just needs to do what he or she has been doing with a lab. The dentist should numb the patient, prep the tooth and then leave. With CAD/CAM, the team can take over (depending on the laws of the state) and nearly the entire process can be done without the supervision of the dentist. The dentist can be in the other room being productive. And when the restoration is done, come back in to check the work and cement it. If the team member takes the impression, designs the restoration, mills it and either polishes or glazes it, it saves the doctor a lot of time he or she can spend in another operatory. The key is that you have to have your team trained. You have to help them learn how to utilize the machine.

Don’t Let it Be Disruptive

Introducing a new piece of equipment into the office can be huge. Change doesn’t have to be overwhelming. I hear from dentists all the time, “We’re really busy. I don’t know if we have the time for it.” Well, it’s no different whether you have a well-functioning office using CAD/CAM or if you’re sending your restorations to a lab. The doctor does not have to be heavily involved in the design of the restoration…if you train your team.

Integrating CAD/CAM doesn’t have to be disruptive. You should adapt the system to your practice, not adapt your practice to the system. No matter how big or small your practice, you have a certain flow in your office that obviously works for you. Make the machine accommodate the flow of your office. Things don’t have to change drastically.

Yes, you’ll have to learn how to take a good digital impression. But that’s easy with the current generation of CAD/CAM systems. The impression gives you a lot of feedback. You instantly know whether you have a good prep or not, whether you’ve reduced enough, whether you need to do a reduction coping or spot the opposing. You know instantly whether you’ve captured the margins and whether you’ve prepared the tooth properly.

If the team member is doing all that work for you and they say, “I can’t quite see the margins.” He or she simply calls the dentist back, the dentist makes the appropriate modifications and you proceed.

Recognize the Need for Same-day Dentistry

When it comes to implementing the technology, the biggest mistake that offices make is they forget that there is a person attached to those teeth. They’ll say, “My lab is great. My temporaries fit well. My patients don’t mind coming back for a second visit.” This is utter nonsense. I have never met a patient who would prefer to have a restoration done in two visits instead of one. It’s crazy to believe that your patients have all this free time and can come back for multiple appointments.

Discover CAD/CAM’s Potential

When CAD/CAM first entered the mainstream market, many offices bought a CAD/CAM but they didn’t know how to use it to its full potential. This was common because the learning curve was significant. Twenty years ago you had to spend time doing 50 to 100 restorations just to learn how to do a simple inlay. You had 2D software. You had to manipulate a bunch of lines on the screen and imagine that would be a restoration. Today, with proper training, a dentist can do 30 restorations his first month. The learning curve is significantly reduced. The return rate (those who buy the machine and say it doesn’t work out) has dropped exponentially too, because the machine, the software and the results are so good.

In the past, dentists were limited by the materials they could use. We only had one material: feldspathic porcelain, which is a relatively weak porcelain. We had to use that everywhere. Today, a dentist has anywhere from six to ten different types of blocks they can mill—from composite to zirconia to lithium disilicate to feldspathic porcelain. We can do inlays, onlays, implant abutments, bridges…we’re not talking about just a simple little machine anymore. We’re talking about a robust piece of equipment that can serve as a center of the practice doing many different types of restorations.

What’s your experience with CAD/CAM? Have you integrated it? Are you ready to do so? Let’s continue to talk about this massive evolution of technology at Dentaltown.com. – See more at: http://www.dentaltown.com/MessageBoard/thread.aspx?s=2&f=2680&t=233712#sthash.teltjuS7.dpuf

Howard Speaks: And the Band Played On…Again

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Howard Speaks: And the Band Played On…Again
Dentaltown Magazine
August 2014
by Howard Farran, DDS, MBA

When you’re young, everything is black and white. When you’re half a century old, everything is 50 shades of gray. And as you get older, you see patterns.

I remember my senior year of high school when two men were dying of something called Kaposi’s Sarcoma in a hospital in California. This was strange because the two men were young and the cancer was something typically only found in the older population.

Then researchers found out both men were gay. When they crunched the odds of this, it caught the attention of the Center for Disease Control and Prevention (CDC). Soon the numbers grew to prompt a medical investigation.

A New York Times article dated July 1981, reported: In the United States, [Kaposi’s Sarcoma] has primarily affected men older than 50 years. But in the recent cases, doctors at nine medical centers in New York and seven hospitals in California have been diagnosing the condition among younger men, all of whom said in the course of standard diagnostic interviews that they were homosexual. Although the ages of the patients have ranged from 26 to 51 years, many have been under 40, with the mean at 39.
This was, of course, the start of the AIDS epidemic of the 1980s. The CDC just hadn’t quite realized yet how widespread and destructive it would be.

In 1987 Randy Shilts published a book titled And the Band Played On: Politics, People and the AIDS Epidemic. A movie stemmed from the book, which premiered in 1993.

The synopsis: Don Francis, epidemiologist and main character, questions the escalating number of unexplained deaths among gay males, particularly in large cities like New York and San Francisco. He starts to investigate the possible causes and keeps tally of those affected by the disease. This list is nicknamed “The Butcher’s Bill.” He talks with politicians, professionals within the medical community and activists and eventually theorizes that AIDS might be sexually transmitted.

Now, we’re more than 30 years beyond this public health nightmare. And hindsight is 20/20. We might have high awareness now but at the time, it flew under the radar for years. And part of the problem was that people refused to talk about it.

In the past, oral and oropharyngeal cancer—or “mouth cancer,” as they call it in the U.K.—have most often been linked to drinking and smoking. And even more specifically, the cancer has been linear—someone who had smoked two packs a day for four decades was more likely to get cancer than someone who had smoked one pack a day for one decade. Chewing tobacco didn’t follow this model. It was less predictable and didn’t get a lot of attention, though still a cancer risk.

Now, the tides have turned. Today we’re seeing an explosion of oral cancer in young girls! Girls who have never had a cigarette in their lives and don’t have a drinking problem. They’re showing up at the doctor with lesions and screening positive for cancer. It’s HPV and it’s hitting us all by surprise. But nobody is talking about it.

You can’t talk about HPV without talking about oral sex… so let’s just get that out of the way. It’s awkward, but you’re an adult, so buck up. Last year the U.K.-based newspaper The Guardian published an article about Michael Douglas, who opened up the conversation about HPV’s ties to oral sex, attributing his own cancer to it.

I get it; you’re not a sex ed teacher, but if we’re going to call ourselves doctors, we need to be asking some tough questions. When I lecture I ask dentists if they talk to their patients about HPV. It’s not even on dentists’ radar.

You should be asking every patient who comes in if they’ve been vaccinated for HPV. Many dentists give excuses. “That’s not my area. Their family physician should do that.” No! We are all on the frontlines of health. If we’re not talking about this, let’s just say we’re not doctors. We’re just molar mechanics.

We have a serious biological problem here: a virus. We’re knowledgeable about AIDS—possibly one of the only positive outcomes of the epidemic—but we’re missing the new problem right in front of us.

I talked to a mother of a patient in my office who refused to talk to her daughter about HPV. And the mother thought that vaccinating her daughter against the virus would be the same as sending her off to college with a box of condoms. She didn’t want her daughter to feel protected. These are huge moral, ethical, religious questions. We need to talk about this stuff, even if it is uncomfortable or controversial.

In 2007, Texas Governor Rick Perry worked to mandate the HPV vaccine among middle-school girls. Though it was controversial and was overridden in the months after, it was one of the only big-time public actions taken against the virus. All 50 states in the U.S. have a Department of Health and Human Services, and nearly every state has a dental division. Have you ever called yours to talk about HPV? Ask for resources. See what the division is doing in your state.

HPV is a topic that makes people squirm in their seats. We don’t want to talk about it. No one wanted to talk about AIDS either. It made people uncomfortable. But the epidemic happened right in front of us anyway. And in a way, we were blindsided! This is what’s going on right now with HPV. The fact is, we don’t know how serious it is or isn’t. And it’s our job— as dentists—to talk to patients and parents about the risks of the disease.

Not only are we not talking to patients, but we’re not talking to each other about it either. I’m on Dentaltown all the time and there is hardly any discussion at all about HPV. Let’s talk about how to educate patients and parents! Let’s converse about the public health risk and our part in the big picture. Americans see a dentist twice as often as they see a physician. We have 125,000 dental offices in America. That’s manpower! We have a massive ability to get out in front of this.

We don’t want to look back at an HPV Butcher’s Bill and ask ourselves what we could have done about it. I’d love for dentists to stand up and become physicians of the mouth. We’ve got a problem on our hands right now.

References

  1. Rare cancer seen in 41 Homosexuals: by Lawrence K Altman; July 3, 1981; The New York Times http://www.nytimes.com/1981/07/03/us/rare-cancer-seen-in-41-homosexuals.html
  2. National Conference of State Legislatures http://www.ncsl.org/research/health/hpv-vaccine-state-legislation-and-statutes.aspx
  3. Michael Douglas: oral sex caused my cancer”; June 2, 2013; The Guardian http://www.theguardian.com/film/2013/jun/02/michael-douglas-oral-sex-cancer?CMP=twtgu

– See more at: http://www.dentaltown.com/Dentaltown/Article.aspx?i=365&aid=4974#sthash.utdmJeBH.dpuf