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Let's Buy a Dental Practice

Discussion in 'Dental' started by The Hammer, Jun 20, 2010.

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  1. The Hammer

    The Hammer Tooth Pimp

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    No Scottsdale is AWESOME!! That is the only other area in the country that I thought about practicing in. I still have a license to practice in AZ. maybe someday........:D
  2. The Hammer

    The Hammer Tooth Pimp

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    There are a couple of ways. First find out what insurances are accepted in the area, most dentists will stay close to what they pay. You can also call around and just ask what they charge for certain procedures. And if you are really wanting the inside scoop get someone who needs a variety of treatment like crowns, partials etc and send them around for "second opinions" and get the fees off of the treatment plans.
  3. chris majdi

    chris majdi Account on Hold

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    do you mean cash flow or net income? either way, i think you're getting to an important point. cash flow is very important for gauging day to day operations; managing this through tight A/R aging is crucial. net income (or more importantly, discretionary net income) is a primary determinant of profitability. looking at either cash flow or net income will tell you how efficiently your practice is running. looking at net income alone can tell you how profitable your practice is, and ultimately how valuable it is. you can have two practices with the same gross collections but very different profiles when it comes to cash flow and profitability.
  4. monreal

    monreal Au pôle nord

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    This thread is not supposed to go down the page. Lets bump it up folks.:)

    The Hammer,

    Most old offices I've seen do not have digital pano and sensors or even screens in the op. How much does it cost to go paperless? like a whole network with a server and computers in 3 ops; install an all digital x-ray system, including panos. I feel this is really necessary in an office, for me to track everything anytime and for the patients to let them see what a "hole in your tooth bigger than your eye" looks like on the screen. Also, would you buy an established practice with enough active patients in an area you know is saturated?
  5. The Hammer

    The Hammer Tooth Pimp

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    Funny you should ask since this is exactly what I am doing in the office that I am buying. I am installing a complete computer system with servers in 3 ops, digital x-ray, 2 new Gendex x-ray units and I am converting the pano to digital. Eventually I am going to buy a digital pano like I had in my old office but those can be pretty expensive so for now I'm just going to convert the old one.

    The grand total for these improvements is going to be right at about $52,000. I'll try to find the estimates for the equipment I'm buying and post it.
  6. monreal

    monreal Au pôle nord

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    How do you "convert" to digital pano? is it like scanning every xray you take?
  7. monreal

    monreal Au pôle nord

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    Btw. OUCH! for the 52 grand!
  8. The Hammer

    The Hammer Tooth Pimp

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    Using Gendex Scan X with phosphor plates and Apteryx software. I would prefer a "true" digital pano but right now for me cash flow is very important but in a year or so I'll get another Planmeca:thumbup:
  9. The Hammer

    The Hammer Tooth Pimp

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    Yeah, welcome to the wonderful world of general dentistry:)


    But one piece of advice I would give any new grad is to invest in a very good computer network with computers in all ops, break room and the doctor's office connected to a mainframe computer. Also make sure that you can e-file insurance claims from day one. And also invest in digital x-ray, man that makes all the difference in the world when diagnosing
    Last edited: Jul 22, 2010
  10. Rlow04

    Rlow04

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    Why do you recommend servers in every room? Do you mean a computer connected to the mainframe server?
  11. The Hammer

    The Hammer Tooth Pimp

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    Yes, please forgive my luddite's grasp of IT speak. I mean a computer in every op. It allows your RDA's and RDH's to make appointments while the patient is in the chair and to post their procedures to the ledger so that by the time that the patient gets out of the chair and to the front desk, they already have a "walk out" statement for them and will know how much the patient owes for the procedure that they just had and can get payment. It prevents communication failures between the front office and the ops and cuts down on a lot of unnecessary motion.
    Popey likes this.
  12. joyride

    joyride Member

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    What software do you recommend using?
  13. The Hammer

    The Hammer Tooth Pimp

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    Dentrix. I started using Dentrix in 1995 and I've never looked back.

    When I was at Midwestern I had to learn to use Axiom. If you used Axiom in private practice you would go broke in a month. I would rather use an abacus than Axiom.

    Comparing Dentrix to Axiom is like comparing driving a Ferrari 559 GTB Fiorano on the autobahn verses sitting on a rock and hoping it will eventually move.
  14. Oracle DMD

    Oracle DMD Chuck NOracle DMD Moderator Emeritus

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    :thumbup::thumbup::thumbup:
  15. jay47

    jay47 Think Positively!

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    Lol, pretty funny Hammer.

    How much with Dentrix set you back? How much will other software manufacturers set you back?
  16. The Hammer

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    At the time (1995) it was about $900. I let you know what it costs me once I get the estimate. As far as other software I really couldn't tell you because they won't publish their prices.

    Remember, most dental software will do what you want it to do. What you have to consider is:

    1. Is your software's company going to still be around in 10 years or will it disappear?
    2. Can the high school graduate that you hired to work in your office navigate the software like she does her facebook account.

    The software that you use needs to have a pretty shallow learning curve as you never know how IT savy the people that you hire will be and you don't want there to be a big lag time as they learn how to use it.
  17. Oracle DMD

    Oracle DMD Chuck NOracle DMD Moderator Emeritus

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    eaglesoft! ftw! hahaha
  18. joyride

    joyride Member

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    What about digital sensors/plates? Which brand did you get and which software?
  19. omaralt

    omaralt Senior Member

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    lol axiUm is only for universities; i dont believe it's meant for private practice.. i recently got an estimate for digitizing my office (just for comparisons sake). each operatory (4 operatories) get a comp with two montiors. the patient has a montior mounted on the wall the comes out to in front of the patient. one more comp in the front desk and a server. all dells. one dexis sensor (can only afford one at this time) and all the software is gonna set me back ~$45K. this is through henry schein with all installation, setup, etc. btw, hammer; dentrix is gonna set you back ~$8K... a long way from that $900 :)
  20. GoldTigerPirate

    GoldTigerPirate I'm on a boat

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    I must say, Doc, your avatar is legendary...
    Last edited: Jul 23, 2010
  21. KinKs

    KinKs

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    Hammer,

    I just want to tell you thanks for screwing me over. The most interesting posts I have ever seen in my two years on SDN happen to coincide with my "study-time" for the NBDE pt 1. This was a planned to make me fail.

    Finally someone is giving us real world advise without the huge piles of BS that is all too often posted.

    Awesome, thread keep it going.

    KinKs
  22. David1991

    David1991

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    I was shadowing my dentist today and noticed the system he had up was Dentrix.

    Hammer, what would you say the average dentist's income is before and after taxes are taken out?
  23. The Hammer

    The Hammer Tooth Pimp

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    For now I'm using Gendex Scan X phosphor plates and a Scan X scanner. The software I'm using is Apteryx. I like the phosphor plates because they are a lot cheaper and easier to use than a true digital scanner.
  24. The Hammer

    The Hammer Tooth Pimp

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    But of course, if something makes a dental student's life more frustration then IT MUST BE USED!!

    The $900 was just for the Dentrix software. I set up my own network and I had 3 computers at the front desk and one in the back and I think the whole thing cost me about $5000.

    My new set up is going to run about $12,000:(
  25. Drabuisa

    Drabuisa

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    Hey Hammer,

    What's up with the Pankey institute? I personally only know of a few dentists that went there, but they are all making crazy money. One in particular in Ohio. They also are real big on warm towelettes and neck massage pillows in their practices. generally, is everyone that works with them fairly successful?
  26. The Hammer

    The Hammer Tooth Pimp

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    Wow, that is a tricky question because it depends on so many things so I will give you my WAG ( wild a s s guess)

    An average general practice dentist in their own practice say 2-5 years out still paying off school/practice debt will probably be making anywhere from $150,000 to $190,000 pre-tax.

    Once you have paid off that debt and have been out for 6 or more years you can make as much as you are willing to work for. I would say on average that could be anywhere from $176,000- $250,000 or much more if you hustle.
  27. The Hammer

    The Hammer Tooth Pimp

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    Here's the deal on Pankey. Most of the dentists who go there are fairly successful to begin with but they want to take things to another level. Pankey shows you not only how to do the very complicated restorative stuff but they also show you how to better manage your practice.

    I'm a Pankey Scholar which means that I took all the courses including the mastery classes. I also did all of the Frank Spear courses as well.

    These courses teach you the skills necessary to do the very involved cases that will bring in the big bucks. But here is the real trick, just because you learn it doesn't mean that you have the huevos to do it in practice. That is what really separates the dentists who practice dentistry the way that they want to and the dentists who wish that they could practice that way but are too afraid to make the change. If you want the rewards you must take the risks.

    If I were a new grad I would go to the Scottsdale Center now rather than Pankey. All of the best people from Pankey work for Frank Spear now and all of my Pankey pals are out in Scottsdale teaching.
  28. Drabuisa

    Drabuisa

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    So would you recommend that a new grad work in private practice for some time to get good at the basics before going to Scottsdale or should you just hit up scottsdale right off the bat? I'm wondering because I want to really get into the more complicated stuff once i'm in private practice. I also want to be a beast at dentistry like you:cool:
  29. The Hammer

    The Hammer Tooth Pimp

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    Get comfortable with being in private practice first and get comfortable with the simple stuff too. Then crank it up and put it out. Here's the reason to do the simple stuff first.

    1. Getting the basics of running the business under your belt will allow you to confident when you start changing your practice dynamic to allow you to do the bigger stuff. It is not just a matter of you knowing how to do the advanced restorative stuff, you also have to know how to get your staff and your patients to buy into your vision (or as I like to call it "get them to drink the Kool-Ade"). Trust me, winning over hearts and minds is the hardest part of running a private practice. For me it was the hardest most frustrating part of taking my dental practice to the next level. You can't show a moments doubt or any lack of resolve one you have set off down that path. Feeling like you have a good handle on running the business is a great foundation to build your dental dynasty on.

    2.Get a good foundation with the simple stuff. All of the more complicated stuff is based in a good knowledge of the fundamentals of dentistry. Being able to cut a good crown prep, restore a tooth to function etc. All of advanced restorative dentistry starts with the basics and builds upon them.

    So yeah go out into practice for a couple of years, get confident in your skills and gain the confidence of your staff and patients and then go seek out the best of the best in dentistry and pester them to show you all that they know. Then start to write your own grand chapter in the big book of dentistry
  30. jay47

    jay47 Think Positively!

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    So, let's say you build your own network like I would and build your own computers as well for 5 operatories. Can you just purchase the software and digital machines? $45 seems awfully steep for that setup to me, but I really have nothing to compare it to.
  31. malyndmd

    malyndmd

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    Great discussion here. :)
  32. The Hammer

    The Hammer Tooth Pimp

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    Here is a estimate my IT guys gave me for setting up my office:


    ( 1 ) Dell PowerEdge T110 Series Server $2,663
    PowerEdge T110 Chassis with upto 4 Cabled Hard Drives
    Intel® Xeon® X3430, 2.4 GHz, 8M Cache, Turbo
    Windows Server 2008 R2, Standard Edition,x64, Includes 5 CALS
    5-pack of Windows® Server 2008 User CALs
    8GB Memory (4x2GB), 1333MHz, Dual Ranked UDIMM
    Keyboard and Optical Mouse, USB, with 17" LCD Monitor
    HD Multi-Select
    PERC S300 3Gb/s SAS/SATA Internal Software RAID adapter
    QTY 3: 250GB 7.2K RPM SATA 3.5" Cabled Hard Drive
    (RAID-5 Configuration / 500GB Usable Storage)
    On-Board Single Gigabit Network Adapter
    Baseboard Management Controller
    DVD-RW Drive, Internal
    Electronic System Documentation and OpenManage DVD Kit
    3Yr Basic Hardware Warranty Repair: 4hr 5x10 Onsite After Diagnosis
    Power Cord, NEMA 5-15P to C13, wall plug, 10 feet

    Valued Customer Discount 12.0% Discount from Dell.com price - 319.56

    (1) 1250VA (750w) UPS w/ AVR $180.00

    (1) AVG Anti-Virus Network Edition 10 $499.99
    Computer Edition - 2 Year Subscription

    (1) 16 Port 10/100/1000 Gigabit Network Switch $199.00

    (1) SonicWall TZ 100 Security Appliance with TotalSecure $399.00
    TZ 100 Firewall/VPN/Security Appliance - 10 Node

    (3) Dell Optiplex 380 Business Desktop PC $2,757.00
    OptiPlex 380 Desktop Base Standard PSU
    Genuine Windows® 7 Professional, 32-bit, English
    Intel® Core2 Duo E7500 with VT (2.93GHz, 3M, 1066MHz FSB)
    4GB DDR3 Non-ECC SDRAM,1066MHz, (2 DIMM)
    Dell USB Entry Keyboard
    Dell E Series E2010H 20in Wide Monitor, VGA/ DVI
    Integrated Video, Intel® GMA 4500
    160GB 7,200 RPM 3.5" SATA, 3.0Gb/s Hard Drive with NCQ and 8MB Cache
    Dell USB 2-Button Entry Mouse with Scroll, Black
    16X DVD+/-RW SATA, Roxio Creator / CyberlinkPowerDVD
    Dell AX210 USB 1.2W Stereo Speaker
    Documentation, English, with 125V Power Cord
    Resource DVD - contains Diagnostics and Drivers
    3 Year Basic Limited Warranty and 3 Year NBD On-Site Service

    Valued Customer Discount -$330.84
    12.0% Discount from Dell.com price

    (3) 600VA Battery Backup Unit (UPS) $237.00

    (3) Dell Vostro 3700 Business Notebook PC $2,847.00

    Genuine Windows® 7 Professional, 32-bit, English
    Intel® CoreTM i3-350M Processor (2.26GHz, Dual Core/4 Threads, 3MB
    L3 cache)
    4GB Shared Dual Channel DDR3 at 1066MHZ, 2 DIMM
    Keyboard with Gesture Touchpad
    Intel® Graphics Media Accelerator HD
    320GB 7200RPM SATA Hard Drive
    17.3 inch High Definition LED Display (1600 x 900) with Anti-Glare
    90 Watt AC Adapter with cord wrapping
    Dell Wireless 365 Bluetooth 2.1 Module
    8X DVD+/-RW with double-layer DVD+/-R write capability
    Integrated 2.0MP Webcam and Digital Mic
    Wireless Network Card 802.11 b/g/n
    Microsoft® Office Starter 2010
    Aberdeen Silver Base 6-cell Lithium Ion Primary Battery
    3 Year Basic Limited Warranty and 3 Year NBD On-Site Service

    (2) Microsoft Office Home and Business 2010 $318.00
    (For front desk PCs - Includes Word, Excel, PowerPoint, Outlook,
    & OneNote)

    (1) Dymo Labelwriter 450 $125.00

    (6) Cables To Go RapidRun VGA Wall Plate w/ open keystone jack $354.00
    (For Network/VGA connection behind laptop and
    COAX/VGA connection behind TV)

    (3) Cables To Go 25' RapidRun VGA Audio/Video Runner Cable $225.00
    (For patient view connection to TV)

    (6) 3ft HD15 UXGA + 3.5mm Stereo Audio Monitor Cable $174.00
    (For patient view connection to TV)

    SubTotal $10,327.59
    Sales Tax $ 1,031.32
    Shipping / Handling $ 250.00
    Total $11,608.91
  33. The Hammer

    The Hammer Tooth Pimp

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    Holy Crap! This thread has had over 20,000 views!:eek::D
  34. Cold Front

    Cold Front Supreme Member

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    :thumbup:
  35. Drabuisa

    Drabuisa

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    Whenever a tooth pimp that excels in all the qualities of tooth pimpdom starts droppin knowledge, the young tooth pimperschnaps (tooth pimps in training) gather around and listen:cool:
  36. The Hammer

    The Hammer Tooth Pimp

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    Sig worthy:D
  37. anishannayya

    anishannayya

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    Holy Crap! They are milking you! Oh well, an extra couple thousand bucks is nothing when you add it all up. But its nice knowing that my cheap ass can save even that small amount by setting up my own tech stuff.

    BTW, for the server, stick to RAID 1. It'll cost you a bit more in hard drives, but it will be well worth it. Recovering from a hard drive failure in RAID 5 can literally take days. If another hard drive were to fail during the time you were rebuilding the array, you would be screwed and loose a whole lot of data. If you can do RAID 6, that would probably be the best option (essentially RAID 5, but with dual disk redundancy). If I just confused you, check out RAID on Wikipedia, they have some great graphics.
    Last edited: Jul 24, 2010
  38. The Hammer

    The Hammer Tooth Pimp

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    I'll take your word for it. This was one of four treatment plans that my IT group gave me. After I read your post I check and two of the others had RAID 1 on them. I called the guy who gave me the estimates and said "I have been advised to use RAID 1". He was a little surprised and said "so now you are getting advice on our advice"LOL. Thanks for the info

    Yes you will save money if you set your own system up but even more important is you will be able to fix any problems yourself rather than lose production time waiting for the IT guy to show up, not to mention the service fee that they would charge you. Also you have the possibility of getting another business going by doing dental office's IT work
    Last edited: Jul 24, 2010
  39. David1991

    David1991

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    From what I understand only the top 5% or so of ones class will go on to orthodontics, oral surgery, etc..

    But what if someone just wants to practice general dentistry? Is there any difference in that case between getting say straight A's in dental school vs. all B's? I've always gotten straight A's since freshman year in high school but only because I wanted to open more opportunities, but to be honest if I can still get into the same general dentistry type practice getting B's that I would getting A's I'll take the B's :D
  40. Barkley11

    Barkley11

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    Where did you find this avatar?? This would make a perfect wallpaper for my iPhone!:thumbup:
  41. The Hammer

    The Hammer Tooth Pimp

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    Unless you want to get into a specialty, grades in dental school are unimportant. I did not learn the skills that made me successful in private practice in dental school. In dental school I was a high C to low B student. My class ranking was 35 out of 71 and on practicals I usually got an 88. I learned the basics and when I got out from under the tremendous amount of time wasting activity and lack of progress that I experience in dental school I was finally able to come into my own.

    Dental school taught me nothing about running a practice, the bare minimum about general dentistry and made some things like occlusion and TMD seem like unfathomable mysteries. All that it really did was give me a degree and a license to practice dentistry. My real education started when I bought my own practice.
  42. The Hammer

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  43. ODEP PEDO

    ODEP PEDO AAPD Member

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    Hammer,
    To bring this Thread back to it's tracks and who knows another 20K views,
    after you chose your "gold mine" practice would you care to discuss some other topics such as, loans options, % for interest and % financed for building and practice (i.e. 80% conventional or did you use an SBA loan and needed 10% only...), years to repay, etc and are you using your old corporation, merging or acquiring seller's corporation, started a brand new one... and how long will he be around for your transition, would you bring some of your old staff back to this practice,
    so much more to be shared. thanks
  44. The Hammer

    The Hammer Tooth Pimp

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    Patience Grasshopper, all in due time. I was going to start off on Monday with a series of posts called "Let's all go to the bank" and talk about bank loans but to answer some of your questions:

    1. Right now I am shopping around for the best deal for my practice loan which will be about $350,000. Most banks that do dental financing (and not all banks will) the going rate is about 6.25% for 7 years. Right now however I am talking to Bank of America who will give me a loan from 3 to 15 years with the interest variable upon the amount and the length of the loan.

    2. I have started a new corporation called "Tennessee Center for Restorative Dentistry" I'll show my logo in another thread. When I sold my half of my practice what I really was doing was selling my 50% of the LLC (named "The Dental Office at Rockwood") that I was co-CEO of. That corporation is still active and is owned wholly by my ex-partner

    3. The owner is selling me office. The office complex that it is in is owned by 5 other doctors and is a corporation also. He is selling his 1/6 share for $130,000 and is owner financing it for 10 years at 7% (SWEET!!) I will more than likely pay him off completely in 3 years

    4. I have a restrictive convenant on rehiring my staff for 3 years. In the covenant if I rehire any of my old staff within that 3 year period I have to pay my ex-partner. It would be $7500 if I rehired any of my hygiene and $5000 for everyone else. So rather than give you an answer I want to see how you guys are thinking. I am rehiring one of my old staff, who do you think it is: Hygiene, assistant, Office manager or receptionist?
  45. The Hammer

    The Hammer Tooth Pimp

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    Here is the logo for my new practice

    [​IMG]
  46. Oracle DMD

    Oracle DMD Chuck NOracle DMD Moderator Emeritus

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    sweet!
  47. The Hammer

    The Hammer Tooth Pimp

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    Yeah I got embroidered patches of this logo. PM me if you want one
  48. DrDientes

    DrDientes

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    If you were to rehire one I would say you are probably rehiring the office manager. Those workers usually take no bull from anyone when you are at the office trying to swindle them from paying the full amount.
  49. The Hammer

    The Hammer Tooth Pimp

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    Hmm interesting approach, anyone else care to chime in?
  50. DropShot 2014

    DropShot 2014

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    I would think that it would be a no-brainer to rehire the OM. You can always train someone to answer the phones for you. Especially, if it someone who you have worked with and are comfortable with and they share/understand your vision for the practice, then they are worth 10x what you would have to pay your ex-partner, am I right?
    It does suck to have to give your partner the satisfaction of paying him even more money, but I say just suck it up and then use the OM to dominate!

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