The Dental Desk - Issue #3 : simplebooklet.com

CEO s Message Inflation rising costs inconsistent patient commitments and staff requesting more flexibility than ever Looking For Featured Practice Listings CLICK HERE Navigating these days will take courage knowledge and a great support team Some of the most challenging times for practice owners are still ahead The market seems to have gone from a seller s market to a somewhat balanced market overnight and it s due to the rising cost of operating This is causing margins to quickly get chipped away at and rising interest rates are also a contributing factor More than ever before we are seeing practices with lower than 10 profit when it should be double that The next 6 12 months will truly separate the business oriented owners from the ones who haven t had to put much effort into growing or even sustaining their business or practice value in the past Page 5 Ask The Expert What s Happening In The Current Marketplace Page 8 7 Habits of Highly Effective Dental Practice Owners Page 12 5 Ways To Increase Ortho Production In The Next 30 Days Owners who continue to grow and pay attention to expenses even in difficult times will be the ones who prosper in the long term Set yourself up for success with a supporting cast including someone who knows how to maintain the value of your practice If you have questions about your local marketplace we have answers DARREN SHANAHAN Founder CEO Avail Dental Exit Advisory Services THE DENTAL DESK MAGAZINE 2 Avail Dental has been a trusted resource in the dental industry since 2012 www AvailDentalAdvice com

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TEMPERATURE CONTINUES TO RISE Practice Owners Being Stretched Dental owners have never seen costs like they are witnessing now not to mention the flexibility staff are requiring in their schedules by Darren Shanahan The overall level of stress most owners are feeling is normal yet figuring out where to go from here seems like anything but Having a trusted advisor under your wing to analyze your local marketplace and help you predict the best path forward is something more and more dentists are coming to us for Personal self care care for your patients and also the mental health of your staff should be of utmost priority in your workplace WHISTLE WHILE YOU WORK Business owners have been navigating new roads for the last few years and just when things were starting to look up the world economy and inflation has other plans Rising costs continue to chip away at margins dental practice owners are used to Passing on the cost to patients at this time seems like a hard ask as most insurance companies haven t adjusted Now more than ever owners are also being asked for flexibility in scheduling than at any other time in dentistry Childcare illness and other commitments have crept into the workplace as increased demands are being placed on all of us Proper business planning and experience will help insulate you from taking a wrong turn in the heat of it all by reducing emotional decisions and getting an independent third party opinion If you d like to speak directly with Darren please call his cell phone 403 862 7406 www AvailDentalAdvice com THE DENTAL DESK MAGAZINE 3

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Over the last several weeks we’ve been receiving some questionsfrom the dental community. Our experience in brokering andappraising hundreds and hundreds of practices has made us a naturalplace for professionals to turn with their questions. We realized thatseveral people had the same questions and so we thought this mightmake a great forum for people to ask their questions anonymouslyand receive their answers. Therefore, ‘Ask the Expert’ was created.Please feel free to send us an email with your questions toDarren@AvailDentalAdvice.com.Q: Is it true that corporations are offering ‘crazy’ multiples forpractices?A: While there have been, and are, some circumstances wherecorporations have offered unusually high multiples, this is not thedaily norm. Corps or DSO’s look at each situation closely and thendetermine (if the clinic fits into their overall plan) how aggressivetheir multiples offerings will be. In reality, only an extremely smallpercentage of practices are offered ‘crazy’ multiples. Q: I’ve heard banks have really tightened up their lending in thedental world. What have you been experiencing?A: In general terms, the major banks have opened up financingagain. However, while many clinics are still grappling with pandemicfall-out, banks have tightened up their adjudication process andcontinue to scrutinize deals at a higher level than ever before. This iswhy, now more than ever, banks are requiring full appraisals,detailed information and interim financials before granting approvalfor financing. This also explains why, in recent months, clients whowere once able to easily secure financing are either being declinedor are required to provide far more information than was previouslyrequired. This is particularly true of multiple clinic owners.CANDID COMMENTARY ON PRACTICE VALUATIONTHE DENTAL DESK MAGAZINE  | 6The "Omicron Effect" On Your Practice:Call Us To Learn More.In order to prepare for the future,In order to prepare for the future, you must consider the past.you must consider the past. We can help.We can help. 1-866-Go-Avail1-866-Go-Avail ((1-866-462-82451-866-462-8245))

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Q: How is the current economic environment affecting practices?A: The truth is that the last 18 months has put a tremendous amountof financial strain on practices, and has tightened the profit marginsfor practices. This is resulting in owner-fatigue for some and moreowners question how much longer they want to both own/manageand practice dentistry. Others have tightened their belts and madedifficult decisions to keep an efficient bottom line, by reassessingstaff and hours, watching their ordering more closely, and cancellingadvertising contracts that are not showing a more immediate impactetc. Ultimately this has marginally impacted the number of practiceson the market (as some have chosen to exit early while some havechosen to hold on and work to increase their profitability beforeselling). We expect the rising interest rate environment to slightlydampen buyer enthusiasm in the marketplace.Q: Does Avail handle specialties such as orthodontics,periodontics, prosthodontics, endodontics and maxillo facial etc?A: We most definitely do handle all of these specialties and more. Infact, we even have a dedicated national rep, Lori William, who workswith our orthodontic clients. In addition to these, we also work withcosmetic spas, chiropractic and massage therapy clients, pharmacy,optometry and opthamology and much more. We specialize in allhealth-related industries.THE DENTAL DESK MAGAZINE  | 7Have a confidential question?Have a confidential question?Email Darren:Email Darren:Darren@AvailDentalAdvice.comDarren@AvailDentalAdvice.com

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Practice self improvement througha willingness to learn and stayupdated in your profession.It’s easy to feel bored ordiscouraged by required CE hoursand mandatory seminars, however,approaching these requirementswith a different attitude can makeripple effects throughout yourclinic. We all know the saying‘education is a privilege’ butsometimes we forget that it is aprivilege for us personally. If wecan approach CE hours andseminars with open minds andenthusiasm, in addition togenuinely learning new things, wewill also be viewed as people whohave a thirst for knowledge andwho consistently invest in thebetterment of themselves, theirteam and their patients.BY YVETTE SHANAHANHave you ever looked at one of yourcolleagues and thought, ‘wow - thatdoctor really has it all figured out’? It’s not uncommon, in anyprofession, to look around andwonder about someone else whoseems to be doing it better. Sometimes it can feel like we’re ona treadmill, a never ending work-eat-sleep cycle and yet, ourneighbour, colleague and / or friendseems to have an endless supply ofpositivity and energy. There is no secret to the perceived‘success’ we see, but time and timeagain there are commonalities inhow these successful people goabout their daily work and personallives. The following are 7 suggestions ofhabits you can adopt that will helpyou to restore your energy, enjoysuccess and find your balance!Dentistry is team work! Be good toyour team.Daily (or weekly) meetings orhuddles are a great way to makesure your team is focused on thesame goals. It’s also an ideal timeto recognize contributions, offerencouragement and expressgratitude for all of your teammembers. Team members who feel seen,heard and appreciated will rewardyou with dedication, loyalty andhard work.THE DENTAL DESK MAGAZINE  | 8

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5 Focused but flexible 7 HABITS CON T Stay focused on your plans but be adaptive When you were graduating from dental school you most likely dreamed of what your dental practice would look like one day You probably imagined what your patients would be like and what kind of team you would gather to work with It s important to always remember those dreams and goals and to regularly check on the progress you are making to achieve those goals 3 Marathon not a sprint Remind yourself that Dentistry while profitable is not a get richquick scheme Remind yourself daily of the many reasons you chose the profession of dentistry outside of its financial benefits While dentistry can offer a very comfortable financial situation for yourself and your family it is important to keep in check that money is only one of the many rewards that come with a lengthy fulfilling career 4 Mindset is key Have an entrepreneurial mindset Being a practicing dental owner requires you to wear many hats scientist retail specialist financial genius human resources officer and yes entrepreneur An entrepreneurial mindset really encompasses most of these hats Read books attend seminars and study ways that you can adopt an entrepreneurial mindset it will make a tangible difference to the success and value of your practice A good goal would be to spend approximately 25 of your CE hours on business learning vs clinical learning THE DENTAL DESK MAGAZINE 9 www AvailDentalAdvice com However remember to also be adaptive because as we grow and change the picture of those goals and plans may grow and change too Adhering too closely to that first dream may end up pigeon holing your success

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Maintain contact and open communication with your advisors.The most successful professionals in the world are not stand-aloneindividuals. They are effective leaders who have surroundedthemselves with professionals who are smarter and more talentedthan themselves. That’s not to say that your lawyer, accountant orbroker would do better dental work than you. It simply means thattrusted and empowered advisors can and will work to cover all of theareas in your professional life that are not your specialty. It meansthat these advisors free up your time so that you can concentrate onyour specialty - being in the office, being in the chair, being withpatients.Maintain a balance between professional work and personal life.This may seem like an obvious one, but take time for self-care, fordowntime, for family, and for fun. Daily professional life, and dailyownership requirements can create very real and very big stressors.It is vitally important to take care of yourself and be present in yourfull life. Taking care to not burn out helps you to create a morerewarding career and a more rewarding personal life. Nobody wantstheir tombstone to read ‘Here Lies A Great Professional’. Enjoy yourwork and enjoy your personal life.THE DENTAL DESK MAGAZINE  | 10www.AvailDentalAdvice.com

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within your four walls that isresulting in patients seeking asecond opinion or going elsewherefor their orthodontic treatmentwhich has a direct impact on yourbottom line.Five quick tips to increaseproduction within 30 days:1.Pending Lists. Contact allpatients that did not book withinthe past ninety days to scheduletheir start.Use all communicationmediums available including phone,email direct messaging and textmessages.2.Book all new patients with anappointment within 72 hours at thelatest, even if a virtual consult for ameet and greet. ContinuedLORI WILLIAMAs orthodontic business owners,we are faced with hundreds ofclinical decisions every day; weaccept this as part of our clinicalresponsibilities. What about theactual business decisions we arefaced with on a daily basis? Withthe ever-changing market, fickleconsumer demands, evolvingreferring dentist expectations,increasing team trainingrequirements, and increasingregulatory requirements … it neverends.Regardless, it is our job togrow and innovate to differentiatethe practice. The reality is, the type of practicethat might have been verysuccessful twenty years agoperhaps may not even survive intoday’s market. You constantly see your expensesincrease month after month asteam wages, aligner bills, rent, andmarketing costs continue toincrease, and the best way tocombat increasing costs is toincrease revenue.That stated, on amonth-to-month basis are you alsotracking lost revenue opportunitiesfrom missed phone calls, neglectedpending lists, emails left with notimely response and maybe worstof all unconfirmed appointmentsresulting in no-shows. This Is Your Reality...You may not think this is happeningin your practice, but I assure youthis with 100% confidence that thereis opportunity for improvement inyour business. You need tounderstand what is not happening THE DENTAL DESK MAGAZINE  | 12

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5 WAYS TO INCREASE ORTHO CON T Booking orthodontic treatment is an emotional decision for your probable patients and consumers want an immediate response Do not think the success Amazon drives from their next day delivery is anything less than a very deliberate strategy Amazon has set the precedent with their customers which are your probable patients and they value immediate responses and instant solutions 3 Whenever possible take a digital scan at every single appointment and reveal their before and after smile 4 Create scripts that deliberately leads probable patients towards same day starts when booking They will appreciate you offering this convenience so they do not need to take more time out of their schedule to come back to start You also eliminate the risk of people changing their mind 5 Conversion Rate You need your Treatment Coordinators to track all their performance statistics and verbally report their successes to you nothing less than weekly This will give you a mechanism to hold them accountable and open up the dialogue to discuss opportunities for adjustment and improvement It s important to stay current and to have your finger on the pulse of your business Our orthodontic team specializes in these specific metrix and provides hands on training and support to spin the needle generating quick results About The Author Lori William AVAIL s National Ortho Rep QUESTIONS ABOUT ORTHO Call Lori William Partner Strategix Consulting Call 403 703 9250 THE DENTAL DESK MAGAZINE 13 Lori William is a partner at Strategix and she focuses exclusively with orthodontic offices to maximize practice efficiency Having indepth experience working in all aspects of an orthodontic practice Lori has the proven ability to overcome all challenges and successfully systematize the inner workings of an orthodontic practice

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$2,484,119 (Practice Value) + $345,000 (Real Estate) Total Asking Price: $2,829,119Ops: 3 (Plus room for additional 3 ops)Gross production: $1,450,509Associate driven practice, owner does limited work in the practiceNet income after all doctors’ fees Ave $261,129 (18% ROI)Hygiene production: 7%Recently added Saturdays and Sundays every other weekRDH: 16 hours a weekDigital charts and Intra oral X-ray/PanNEW LISTING: Calgary, AB Practice - Southern Alberta (Ref#1724)Location: SE Calgary, Retail Strip-mall, Street levelTotal Asking Price: $1,436,212 by Darren ShanahanTHE DENTAL DESK MAGAZINE  | 14www.AvailDentalAdvice.comThis 5 operatory practice has been in this rural community for manyyears. The community is prime for you to add hours and additionalservices to grow this practice. The main level street entrance is highlyvisible and there is ample, staff and patient parking. The practice boastsabove-average hygiene production for a rural practice which keeps thebottom line profitable and prime for additional services.

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Hometown Dental - Where Smiles Come From We are searching for a part-time Dental Associate.Monday and Wednesday with the possibility ofadditional days. The ideal candidate would be looking for a long-term dental home, have a passion for dentistry, akeen interest in a learning-growing mentor-ship, beexcited about technology advancement in theworld of dentistry, have steady energy, be aneffective communicator, and want to be an intricatepart of a solid relationship built practice. If this sounds like you we'd be very pleased tohave the opportunity to meet you. Please sendus your CV in confidence tomanager@hometowndental.ca Need an Associate?Email: Yvette@AvailDentalAdvice.comSend your CV to:apply@smilequestdental.ca

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How do you implement the same strategies in the running of your dental practice, that are used for the care ofyour patients? Too many dentists go about their business just brushing their teeth, basically doing the bareminimum to run the practice. Fortunately most practices over the years have been profitable despite justtreating patients, paying bills, somewhat managing staff and getting their taxes done to keep from getting introuble with CRA. Only about 2-5% of dentists we see annually actually work on their business, by knowing wheretheir practice has been and where it’s going. Are you in the 95% or the top 5%?If we look at the same strategy that you apply to patients (to do regular cleanings and a full check up every 12-24 months, measure the pocket depth, take x-rays, advise patients to floss and how to maintain healthy gumsetc) then why would’t we we apply the same strategy with our business? Frankly, you are not alone. Dentists arenot the only business owners who often go years without checkups or plans, but you have the power to changethat. You can take charge of the ‘hygiene’ for the health of your practice. Start with the equivalent of the 3-6 monthhygiene visit for your practice. Have your bookkeeper/accountant check your income & spending, year over year,and highlight the areas that have increased costs. Or better yet, forecast out what your costs will be in certainareas- as well as income. Highlight areas that you are spending more, or less, so you can see if you are missingany opportunities or whether costs are getting out of control. Come in for the checkup. On an annual basis have your team (or do it yourself) pull some critical reports toreview your practice; hygiene production, overall production by code for the last 12 months, accounts receivable,new patients by month, active patient etc. (If you’re not sure how to pull these reports, you are not alone. Giveme a call and I can help you through it, or you could call your software provider). Do the staff know your visionfor the practice and are they living it with each patient? This information might require some additionalquestions but that is a great thing as it means you are paying attention. Treatment planning - Ask yourself the tough questions: Do I need this number of staff? If so why and what doesit do for me? Many people just keep hiring until the team is happy with the amount of work they have to do vsstrategically knowing who should do what and how long it should take them. When do I add another staffmember? Are we growing or declining? Are we attracting enough new patients to offset the ones that move, orleave, for various reasons? THE DENTAL DESK MAGAZINE  | 17YVETTE SHANAHAN

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Am I planning to add any treatment types and, if so, will they be profitableat the price you set? You would surprised at the number of dentists whoadd a service simply because they want to, and haven’t really given anythought to the cost of that procedure or if they amend out fees to reflectthe extra work. If you have the answers to these questions you will be setfor the next action and be well on your way to keeping your practice inline. This is where you make your plans and how to achieve those goals.Next, you want to get the work done. Much like patients - you want themto get the work you recommended done, and now that you have theinformation to make some decisions about your practice it’s time to get itdone and implement the plan. Rework your staff as needed, re-jig yourmarketing if it’s not working, and don’t replace that third receptionistunless you have grown to where you need to. Ask yourself if your practiceis expanding or staying in the same place? If you choose not to grow yourpractice that is not a problem but don’t let your lack of attention to thesedetails make the decision for you. This is the stage of treatment whereyou implement the plans you have for your practice.Refer out to a specialist as needed. Tax planning comes up regularly andyou need to keep on top of this. For example; some of our current clients,who are also US citizens, are working to make changes as needed toavoid paying excess taxes due to recent changes in US legislation. Youtake a Panograph on a patient, why? Because it shows you a picture ofwhat you can’t see. We as practice appraisers take that ‘Pan' for you andshow you what you aren’t seeing - which is, where your practice mighthave decay or need some items addressed in order to manage this hugeinvestment you have put your heart and soul into. You don’t want to be theperson who hasn’t checked this and then come to find out all of thedecisions you made or didn’t make, have devalued your practice. This is far from a comprehensive list of all of the things you can do tokeep ‘flossing your practice’ but it is a very good start! Keep the value inyour practice by applying the above discussed strategies and keep thegums of your practice healthy! THE DENTAL DESK MAGAZINE  | 18

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Stress is an inflammatory diseasewhen it becomes chronic! We knowthis by the latest research that showshow chronic stress affects our DNAby upregulating our NFkBtranscriptional factor that increasesinflammatory mediators within ourbody and brain. OUCH! This is one ofthe mechanisms in which stressincreases our vulnerability tohundreds of diseases, and becausestressors can be physical ANDpsychological in nature it can explainwhy neuropsychiatric disorders likeanxiety and depression are on therise. The Pandemic has been like a nation-wide stress test that has createdphysical, mental, relational, parental,political, vocational, and financialstress. ContinuedDR. KRISTIN YONT D.M.D.I used to think that life only goteasier, and that practicing dentistrywould become less stressful withage. The last few years havequashed this theory for me as I havefound that practicing dentistry hasbecomes more challenging:Increased expenses, decreasedprofits, workforce shortages,increased administration burdens,“red tape”, and managing higherdegrees of staffing concerns/issues.Tack on a pandemic to all of this andthe stressful uncertainty that itbrings and my hypothesis of easewith age has been rejected (ordenied). I know that it is not just mewho is feeling this professionalangst. Research over the last fewyears shows that all healthcareprofessionals are experiencingskyrocketing rates of burnout andunfortunately an increase in suicide.Stress: …is what the brain does toitself and the rest of the body whenfaced with a threat or a challenge.Our stress response is anevolutionary miracle that has beendeveloped over millions of years tohelp us humans stay safe and tocontinue to procreate. Once our brainperceives a threat amultidimensional cascade ofphysiological events is triggered: theautonomic nervous system “textsmessages” the sympathetic branch(fight, flight, or freeze) to prepare forbattle, and the hypothalamic pituitaryadrenal (HPA) axis “dials up” thehormonal troops to mobilize energy.This is all fine and dandy to ourphysiology until we can not shutthese systems off due to repeated,sustained cycles of our stressresponse being activated! Sciencerefers to this wear and tear on ourbodies as allostatic load. THE DENTAL DESK MAGAZINE  | 19

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We know that stress increases vulnerability to non communicable diseases like cardiovascular disease, diabetes, respiratory disorders,and some cancers. And we can now link stress with increased proinflammatory cytokine productions and a decreased effectiveness ofour immune system to fight viruses. Bam! I predict that the consequences of this will be catastrophic to our long-term biology and mentalhealth. We dental health professionals and our staff are not immune. Okay, enough with the depressing news, lets get to some researched based solutions.Typically, when our mental health gets challenged, we either ignore it (and top up the wine fridge), try to talk it out, or try to medicate it –hoping it just goes away. But research now shows that we have another option in mind-body medicine to help manage our stress relatedillnesses. Mind-body medicine is the research that recognizes the interplay between beliefs, thoughts, feelings, behaviours, andrelationships that can have a profound effect on the body and vice versa. We also know that mind-body medicine can be an effective wayto reduce stress and increase our resiliency to it. What is resilience? The capacity to adapt and overcome stress and adversity while maintaining normal psychological and physicalfunctioning thereby minimizing the impact that stress has on our physical and emotional health. The ability to “bounce back” (and evengrow) after challenging experiences!The Benson Henry Institute for Mind-Body medicine at Massachusetts General Hospital teaches three essential components in its StressManagement and Resiliency Training (SMART) Program:1) Practicing Relaxation Techniques: It is amazing to me how so many of us do not even know how to “hurry up and relax”! We have neverbeen taught this skill. There are so many ways that we can train our nervous system to calm down. The most physiologically impactful:focusing your awareness on BREATHING. I know this sound so “Kumbaya” but rather than judging it, just try it for yourself and see how itfeels. Sixteen seconds: Inhale to the count of four, hold for a count of four, exhale for a count of four, hold for a count of four. Notice howyou feel. Just the simple act of deep mindful breathing activates our parasympathetic nervous system.2) Stress Awareness: There are many ways that stress can affect our own personal responses to stressors. It is important to explore howstress affects our thinking, our emotions, our bodies, our behaviours, and relationships. 3) Adaptive Strategies: It is important to learn how to reapproach, reappraise and reframe our daily perspectives to our stressors. Seeingevents as challenges rather than threats is a coping strategy. Positive perspectives, social connections and healthy lifestyle behaviors arealso important buffers to stress. Unfortunately, when we are in the stress response it is very hard to stay healthy behaviourally andbiologically. Who the hell feels like exercising and eating a salad when they are stressed out?! It is more like, grab me a beer and a bag ofchips! Let’s talk about sleep – it is a downright luxury! I have experienced this as a stress-challenged perimenopausal woman. Stressaffects sleep and not sleeping is a stressor. The good news is there are many mind-body medicine techniques including meditation(which downregulate the NFkB transcription) that can help with sleep. Stress doesn’t have to run our lives. If we participate in our own wellness through mind-body strategies, we can control our body’s andmind’s reaction to stressors and take back our lives!Dr. Kristin Yont DMD (Originally published in the February 2022 ADAC Magazine)Benson-Henry Institute SMART – Certified Healthcare Practitionerwww.mindbodyteacher.com

The Dental Desk - Issue #3

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