6 Ways to a Healthy Practice

I was in an office the other day and I picked up the office newsletter, The Oral Health Report. The cover story was by Dr. Gad Zapatero and titled Phased Dental Care. Dr. Zapatero starts by asking, “Would you like a healthy mouth, a sound bite, and a beautiful smile?” The answer is obviously yes, but for many patients, economics get in the way of optimal oral health. Dr. Zapatero goes on to talke about a phased approach to dental care that could take months or even years to complete.

This sounds exactly like many of the projects I work on. If you look at how dental equipment has changed, many operatories were not built to accept new equipment in the most ergonomic or effective way. Common complaints are cords and wires everywhere, no space for a computer or dual monitors, no counter space, cramped rooms, and trapped assistants. Dental equipment, like dentistry is expensive, and often times to get a practice healthy, the project is extensive. It’s hard to afford all the things that you want, or in a lot of cases, need. I heard a presentation from a colleague last week and he talked about diagnosing the needs of a dental practice to get them healthy. He tells clients when the numbers get too big for the budget, you don’t get lesser quality equipment, you simply get less equipment. His message was not to compromise on the solution to the problem. Maybe it’s similar to a bridge vs. an implant. If it was your mouth, and both options were clinically sound, you would get the implant. Why treat your practice different than your mouth?

How to start
Determine a yearly equipment budget. Work with your accountant to discuss depreciation options to maximize benefit. Work with your equipment & supply team to examine the practice and evaluate your goals.

Replace old equipment at the end of it’s life cycle. Repairs, parts, and service aren’t cheap either. Your budget should include incidentals like vac, compressor, xrays, and sterilizers. These are the emergency items that have to function properly all the time.

Computers have a 3-5 year life span depending on your practice volume. Determine a replacement schedule to be proactive against down time. Lost production costs more than a CPU.

Practice Builders. There are many technologies available that can help fund your equipment budget and grow your practice. Inta-Oral cameras, Panoramic, CEREC, and Digital X-Ray are a few. These items are expensive and need to be planned for. They also carry a significant ROI to offset your investment.

Integrated Technologies. As you begin to replace cameras, computers, and film, look for ways to integrate these technologies into your dental equipment. Wires and cords can be virtually eliminated in today’s operatory with built in cameras, scalers, and curing lights.

Just like Dr. Zapatero’s phased approach to oral health, work with a phased approach to get to the highest level of practice health. Your team and your patients will be feeling better too.

New Office Interview: Serenity Dentistry

Serenity Dentistry

View more presentations from Kevin McGonigal.

I recently completed a new office project with Dr. Solveig Woychuk of Serenity Dentistry in Belchertown, MA. I asked her some questions about her experience, and she was kind enough to share them here.

Tell me about why you decided to build your own practice?

I had my own practice in NY and i really enjoyed it. I tried working for a large dental office and it wasn’t for me, so I decided to start my own practice here in Massachusetts.

What were some of the things you were concerned with as you started thinking about the project?

Finding the right space was important. I had financial questions of course, and I wanted to survey the market the find out where dentistry was needed.

What kind of resources did you seek out for help with those concerns?

The banks that I applied to for financing helped me with that. It was mostly through the financial institutions and word of mouth, people knew I was looking for a space and they were coming to me and telling me this is where they needed a dentist.

You looked at three different spaces, what was it about this space that made it the right fit?

One of the things I was looking for was proximity to my house. I also had a non-compete from the previous place I worked so I wanted to get as close to that as I could without breaking it, and there weren’t a lot of spaces available in this area so I was limited. This landlord was willing to do a lot to help me because this building had not been used very well. It seemed like a good match.

What were some of the challenging parts of this project?

Mostly, I was concerned about the financials but they seemed to come together pretty easily. I was scared, but it all worked out pretty well. I really messed up with the contractor, I can’t say it enough, but I should have gone with an experienced dental contractor. The real challenge was stepping up to a bigger office. My other practice was smaller. I was used to a home office that wasn’t even computerized. Now I was deciding to do all this modern technology and to go paperless. The way I thought of it was if I’m gonna do it I should just do the whole nine yards, just go for it. I knew that if I just kept plugging away, I’d be happy in the long run.

How do you think this new technology will help you communicate and interact with patients?

Ultimately I think its gonna be awesome, but I’m in a learning curve right now. It’s all a little new to me.

What were some of the easy parts of the project?

Decorating. The fun parts, laying it out. Having the experts help me with the layout. I love doing that kind of stuff and I think I’m pretty good at it. I love all the details, everything down to getting light fixtures and the stained glass that runs throughout the office. I liked putting little pieces of my personality in the design.

Does it look like what you had pictured?

Yes. Better I would say. I wish I had more space though, and in retrospect now that I’m not as scared, I should have gotten more space. I could’ve added on another section just to have more room for a staff room, a bigger waiting room. I do want to add another dentist and another hygienist as soon at that’s warranted. I think it’s going to have to be redesigned a little bit if that space is still available.

You were looking at two different supply companies, what made you pick Patterson?

I liked your design ideas and how flexible you were in trying to make them meet what I was looking for. I was really scared of the financial aspects, and you worked on getting me display equipment at a reduced price.

I know financing was a concern. Was there anything you’re glad you splurged on

I would say the first thing that pops into my mind is the digital x-rays. I first purchased phosphor plates and when my hygienist saw that she said, “No, you gotta get this other system, Schick”. The digital x-ray and the patient education will play a large part in how I want to communicate with my patients in this practice.
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Dr. Woychuk’s office has a lot of unique design elements including: glass block, stained glass, and water features. The office is equipped with ADEC 511 Chairs and ADEC 300 delivery units with integrated intra-oral cameras. The office features Schick Digital X-Ray and CAESY Patient education systems.

Interview with a Contractor

I spend a large part of my time working on office projects that are either renovations or total relocations. I started talking with some of the experts that I work with to get their perspective on how to accomplish a project smoothly. In the next few weeks I’ll bring those interviews to you.

Today I spoke with with Craig Sweitzer of Craig Sweitzer & Co., LLC. Craig’s company is located in Western Massachusetts and they have been building dental offices for 25 years. In this interview, Craig talks about some of the considerations and planning that go into the modern dental office.

What should a doctor expect from their contractor?
The planning and construction process can be a daunting task. My clients deserve the highest level of professionalism when working through a construction project. Most doctors are quite busy with their practice and cannot waste time, effort, and money on a poorly conceived or executed construction project. The contractor’s background and experience are quite important. Dental offices have complex mechanical requirements and dentists tend to be demanding customers. Their profession requires perfection and they tend to expect the same of their contractors. This is only natural.

When a doctor is looking at a space for a dental office, what are a few things they should be on the lookout for?
Considerations for a new location include zoning, parking, traffic flow and count, building configuration, and local infrastructure such as sewer and water. The availability of city water and sewer make installations easier. Some buildings require fire protection sprinklers and city water becomes necessary. If a building is being considered where city water and sewer is unavailable, construction options are limited.

What are the differences between a concrete slab vs. a space with basement or ceiling access?
A “slab on grade” means a concrete floor with no access to the underside. Since dental offices require so much under-floor plumbing for drains and suction, cutting and removing paths of concrete is required to install this plumbing. This will involve more work, noise, and mess than a space with a cellar access. A space with a basement or located on the second floor space allows easier plumbing access, but that being said, most of the offices that we do involve cutting a concrete floor.

What about the bathrooms? How many? How big?
The Americans with Disabilities Act (ADA) requires most offices to be handicapped accessible, which means handicapped bathrooms, access ramps, and adequate doorways, among other requirements. If the building has common bathrooms that meet the ADA specifications, the project is not as complex and space for these bathrooms is unnecessary within the planned doctor’s office. If not available in common space, separate handicapped men’s and women’s bathroom are required. These usually consume about 42 square feet each.

A lot of doctors ask me about negotiating with their landlord. In your experience, what is typical and customary for a landlord to provide?
Many landlords will provide money to the tenant as a build-out allowance upon signing a lease. Others will offer specific work such as a “vanilla box”. This is a newly painted space with the electrical panel, HVAC (heat, ventilation and air conditioning) distribution, a suspended ceiling with lights, and two handicapped bathrooms. At times, money from the landlord toward the build-out is better than the work being done by others which may locate bathrooms, doors, or windows in a location that doesn’t fit with the flow of the doctor’s planned office and operatory layout. Some properties are only offered as is. If the price is right, it may be a good option.

Typically I recommend that the size of the usable space should be 400 sq.ft. x # of desired operatories to get everything you need, what has been your experience?
Obviously, too much space adds costs beyond what is efficient and too small can be a mistake because it minimizes space for expansion, storage, private office or bathroom, or an employee lounge. Most offices we build have future operatory rooms planned and the rough plumbing and electrical installed for future equipment and use. It’s been our experience that these expansions will typically be finished one to five years after the original office opens. Most offices we do range between 1,200 and 2,400 square feet.

When a doctor decides to open a new office or to expand an existing space, what’s next?
There are generally two routes that a doctor takes: he or she either contacts the equipment specialist (ES), or contacts me and I bring in the ES. Patterson and I consult with the doctor and Patterson draws a preliminary floor plan. Most include a waiting room, a receptionist and payment area, lab and sterile area, 4-10 operatories or hygiene rooms, an employee lounge, bathrooms, storage areas, private office and consult area. Some doctors prefer an employee entrance separate from the patient entry.

After the basic floor plan is generated, we are happy to give a “ball park” estimate for the build-out. Subsequently, the equipment and the office layout and interior finishes are finalized and a construction contract with final pricing generated. I supply a licensed architect, if required, and some doctors request that a designer be brought in to help with finishes, artwork, and furniture. Patterson and my company present the doctor with a complete package. Our flexibility allows us to meet the individual needs of the doctor.

The final bid and contract price usually includes all work to be done within the space including building permit and architectural fees, all mechanical systems such as plumbing, HVAC, and electrical, and room construction including walls, doors, ceiling, trim, wall and floor finishes, and accessories. The facility is ready for the installation of the dental equipment.

Why do you see projects go over budget or over time?
Due to complexities and unknowns that may exist at the start of the project, costs can be listed as allowances for some items so that final choices can be made as the job progresses. Planning and final design takes many resources and often a client wants to complete the preliminary construction work before these final details are completed. That is when a contract can be written on a “cost-plus” basis. Changes to the scope of work or unforeseen conditions will sometimes make a job more costly or take longer than anticipated. It’s not unusual for a client to decide to upgrade some finishes or add features as the job progresses.

What are some of the typical options that are available?
Our basic office includes standard suspended ceilings, vinyl floor tiles in patient areas and carpet in other areas, painted walls with some trim using tasteful colors and accent walls, soffits and a custom reception desk with laminate top. Up market designs can include custom woodwork, solid surface tops, drywall ceilings with crown mounding, moulded doors, ceramic tile, accent glass and lighting, raised paneling and trim, soffit assemblies, wall covering, and waterfalls, atriums, planters, or fireplaces. Really your options are only limited by your imagination and budget.
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Craig Sweitzer has been building dental offices for 25 years. Craig has a B.S. in Business Management, and state licenses as a construction supervisor and real estate sales. He is the chairman of a local planning board, and has served as building inspector and as a commissioner to the regional planning commission.

Is Everything OK?

I was out to dinner last night with my in-laws at my favorite restaurant. My wife’s parents are gluten free and have several other dietary needs that make going out to eat difficult at times. I knew this restaurant would be very accommodating and they were with a gluten-free menu and the promise to cook the meal however was necessary. The food is always great and last night was no exception, but the overall experience left something to be desired.

If we look at this from a buying process point-of-view it went something like this:

1. Customer had a need (hunger) and some stipulations (gluten, salt, and dairy free)
2. Sales person had a solution and promises of a great experience.
3. Customer buys the solution.

What happens next is were great products and brands take the hit. All too often, the solutions and promises don’t match the real life experience. Last night it went like this:

4. Someone other than the waiter delivered the meal, and the plates were put in front of the wrong people. One meal also came out wrong.
5. Waiter returned after a few minutes with the correct dinner, but didn’t acknowledge or apologize for the mistake.
6. Waiter never returned to ask if everything was OK.
7. Waiter did return to sell more wine.
8. Desert order was taken by someone else.
9. Desert came out wrong.
10. Waiter wasn’t even aware of the mistake and delivered the check with a smile and a cheesy joke.

My wife and I always rave about the food at this restaurant, but it would be difficult to recommend them again without mentioning the poor service we received last time. None of the issues were major, but they all left a mark on the brand. Last week I talked about ‘gottas’. You gotta get the service and support right in any business. Your customers have too many choices, and if you get it wrong, someone else will get it right.

How does this apply to your business?
Most of the competing products that you will consider for your office will have similar features and benefits. With the type of technology and equipment that is needed to successfully run a dental practice, one of the most important pieces to any purchase is knowing how you will be supported after the sale. What does the training look like? Warranty? Support, and service? Partnering with someone who can provide the highest level of support after the sale can sometimes be more important than the features and benefits that were promised.

How do you handle follow-up in your business?

If It Ain’t Broke, Don’t Fix It

I am often faced with questions about saving, repairing, and replacing dental equipment that is outdated or has seen a better day.

Last week, Seth Godin talked about an event vs. a process as it refers to social media. I think this can also be applied to the way a dental practice buys its equipment.

When a purchase is focused around an event like the perfect promotion, a great price, or something breaking, it is often an unpleasant experience. Financially it doesn’t fit with the goals of the practice, and philosophically, it may not be the right time to bring a new piece of equipment in.

The process buyer is always planning for upgrades. They are thinking about how they will integrate the new equipment. They are thinking about how will it affect their patients, their team, and their practice. There is a plan, and a budget for turning over old equipment. You know that maintaining a healthy mouth is an ongoing process that requires constant attention and regular checkups. Some major treatment may be necessary, but it can be planned for over a period of time. Maintaining a healthy practice is no different. Work with your business partners to put together a treatment plan, formulate a budget, and build for success over the long haul.

How did you decide to make your last major purchase? Was it an event or a process?