Owning a Practice

[Doctorfish]

Is this still a viable option/will this still be a viable option in the next 5-10 years? I plan on opening a practice in that time frame but I am just really afraid of the practice failing due to over saturation and corporate takeover.
Can I even take out a loan for a practice AND pay student debt off while living a comfortable life? Or do I have to live off beans and rice, rice and beans until I’m done paying off the $1 million of debt. In other words, how much more do you REALLY make as a practice owner on average. As a new grad with $250K of debt, getting an associate job paying $140K doesn’t seem so bad if you can pay off the debt in 5 years.

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[2TH MVR]

It's been said many times that the one clear advantage of being a dentist is the opportunity to own your own small business. There are so many finanical perks (business write -offs) associated with a small business. There's more financial upside to owning. But it is not easy. You have to have some business knowledge.

Unfortunately in saturated areas .... your success will not be soley dependent on YOU or how hard you work. There will be other competitors (Corps, other dentists, etc) who will open next to you if the demographics are good. I work in a saturated area (Phoenix). I practiced privately for 25 yrs and now PT for a Corp . I know what it is like when Corps move to your referral area and literally take over.

I've also seen that the Corps themselves are competing with each other. Typically it's all about who has the lowest fees and can attract the hispanic population here in Phoenix. Somos Dental and Risas Dental are crazy busy here.

So. Yes. Private practice is still a viable option. Soley dependent on LOCATION. Pick the right rural, semi rural location with fewer dentists .... then it becomes easier to have a private practice.

If you have to practice in a saturated city (family, personal reasons) .... then I would work BOTH private practice and have a Corp job on the side. If your private practice takes off ..... you could always quit the Corp job. Diversify your employment.

It all starts with location. And not being held down with extensive DS debt.

 

[maruprime]

No one can tell the future 5-10 years from now. You can always open your own office though. I do want to comment on the loan. I just closed on my business loan to open my own office. I am in an ultra competitive city in California. They take account my student loans. You cannot hide this from them. They also require you to have cash flow, either from the existing owner’s profit/loss statements or if you are building from scratch you need to have another associate job that you will work part time. They also require you to have equity injection of 10% minimum. Pretend you want a loan of $1 million. Well you need to have $100,000 of your own cash to use first. I went through 10 phone calls with small local banks asking for a loan. They told me they aren’t interested in my business, maybe because it was COVID or maybe because of my massive student loan or my lack of cash equity. Finally a big national bank gave me an application and I’ve closed on the loan. It’s not easy to get a loan like it used to be 20 years ago. This is how it is now.

Lastly, in my very large city in California, rice and beans are mandatory with every meal.

 

[2TH MVR]

No one can tell the future 5-10 years from now. You can always open your own office though. I do want to comment on the loan. I just closed on my business loan to open my own office. I am in an ultra competitive city in California. They take account my student loans. You cannot hide this from them. They also require you to have cash flow, either from the existing owner’s profit/loss statements or if you are building from scratch you need to have another associate job that you will work part time. They also require you to have equity injection of 10% minimum. Pretend you want a loan of $1 million. Well you need to have $100,000 of your own cash to use first. I went through 10 phone calls with small local banks asking for a loan. They told me they aren’t interested in my business, maybe because it was COVID or maybe because of my massive student loan or my lack of cash equity. Finally a big national bank gave me an application and I’ve closed on the loan. It’s not easy to get a loan like it used to be 20 years ago. This is how it is now.

Lastly, in my very large city in California, rice and beans are mandatory with every meal.

Definitely easier 20 yrs ago. For an ortho practice .... the ortho supply companies teamed up with some lenders and were tripping over themselves trying to lend me money on the cheap. All I had to do was use their product for a period of time.

 

[allDAT]

No one can tell the future 5-10 years from now. You can always open your own office though. I do want to comment on the loan. I just closed on my business loan to open my own office. I am in an ultra competitive city in California. They take account my student loans. You cannot hide this from them. They also require you to have cash flow, either from the existing owner’s profit/loss statements or if you are building from scratch you need to have another associate job that you will work part time. They also require you to have equity injection of 10% minimum. Pretend you want a loan of $1 million. Well you need to have $100,000 of your own cash to use first. I went through 10 phone calls with small local banks asking for a loan. They told me they aren’t interested in my business, maybe because it was COVID or maybe because of my massive student loan or my lack of cash equity. Finally a big national bank gave me an application and I’ve closed on the loan. It’s not easy to get a loan like it used to be 20 years ago. This is how it is now.

Lastly, in my very large city in California, rice and beans are mandatory with every meal.

And it can be hard to find a practice that cashflow strong enough to support both loans (practice and student), and rent/mortgage. Even if you don't have a mortgage, they factor in cost of living and your lease, so it can be really difficult in HCOL areas.

 

[CharlieAF]

I think it’s totally doable in rural areas. I owned a practice in a rural county of Michigan. Payed off the practice and my loans within ten years. Also was able to buy a nice house thanks to low cost of living.

Granted that was 13 years ago that I bought the practice but it really hasn’t changed. It’s an undersaturated area. My advertising budget was zero and most of the time I had more patients than I knew what to do with. The closest corp dental chain is 30 miles away.

So I think the answer very much depends on where you want to practice.

 

[PerioDont]

Here is real data from a financial firm on the average numbers from all of their clients who actually own dental practices. these numbers are much better than the ADA ones.

This is why you want to own a practice.

Also ain't no one paying down 250k on a 140k salary in 5 years.

 

[Mauricio45]

Here is real data from a financial firm on the average numbers from all of their clients who actually own dental practices. these numbers are much better than the ADA ones.

This is why you want to own a practice.

Also ain't no one paying down 250k on a 140k salary in 5 years.

Net income "Before Non-Operating & Doctor Costs". So, I wonder what is net come AFTER non-operating and doctor costs? And if it's significant?

 

[PerioDont]

Net income "Before Non-Operating & Doctor Costs". So, I wonder what is net come AFTER non-operating and doctor costs? And if it's significant?

yep I wonder the same thing.

I think doctor costs refers to salary of the doctor vs owner profit though, so it would be going to you anyways if you own the practice.

 

[allDAT]

Here is real data from a financial firm on the average numbers from all of their clients who actually own dental practices. these numbers are much better than the ADA ones.

This is why you want to own a practice.

Also ain't no one paying down 250k on a 140k salary in 5 years.

Keep in mind that Cain Watters is an ultra-premium firm, so the clients that select them are already a standard deviation above the average. Most dentists can't afford them. The ADA numbers are on the lower end, no doubt. But likewise, Cain Watters numbers are on the high end.

 

[PerioDont]

Keep in mind that Cain Watters is an ultra-premium firm, so the clients that select them are already a standard deviation above the average. Most dentists can't afford them. The ADA numbers are on the lower end, no doubt. But likewise, Cain Watters numbers are on the high end.

definitely some selection bias involved here

 

[CharlieAF]

Also as an owner there’s the salary you pay yourself... but there’s also the tax breaks you get by paying your health insurance, car expenses, etc through the practice.

We keep it legal and account for that on our W2s but still. It definitely adds up.

 

[charlestweed]

Everything in life is a trade-off. You can’t have everything. When you owe $1million in loans, don’t expect to have a comfortable lifestyle and not have to work hard (aka work/life balance)....you are basically a broke dentist. There are only 2 options: either eat rice and beans OR work extremely hard to increase your income so you can pay off the debts faster. I chose to do the latter (I worked 6 days/wk) because I wanted to drive a BMW. My sister did both: she continued to live like a student (lived with our parents for 3 years, drove the same old Toyota Sienna etc) and worked 7 days a week (3days at her own office and 4 days/wk at the corp). Despite making less than me, my sister is ahead of me financially. While I enjoyed leasing one new car after another, my sister invested her money in real estates. Now at 48, my sister is 100% debt-free, owns multiple investment properties, and only works 3.5 days/wk…treating 1 patient at a time...no more jumping from chair to chair like when she worked for the corp.

 

[ysrebob]

FWIW the Cain & Watters numbers definitely do not represent actual industry averages. You're looking at top-10% outcomes there.

I regards to the original question, I think owning your office remains a viable and desirable outcome, PROVIDED:
- you've got some common sense
- you're willing to work hard and wear quite a few hats
- you're willing to move to an area where demographics are favorable

Dentists who do this may never see "Cain & Watters" income numbers, but they'll almost surely do better than their peers who stayed in associateships.

 

[yappy]

If you don’t own a practice you’re being exploited. These DSO are not operating at a loss and they have the overhead of an executive team baked into their operations. I have had several class mates in the past 2 years step out and start their own or bought an existing and it’s going okay for them. I have a year or two left of DSO due to some family obligations and then I plan to buy or possibly do a start up.

DSO is not a bad place to start but I think if you’re going to work full time it makes sense to have equity in an office.

edit: I had similar loans to you and paid them off in three years. Focus on being debt free ASAP and you will have a lot of opportunities available to you.

 

[2TH MVR]

If you don’t own a practice you’re being exploited. These DSO are not operating at a loss and they have the overhead of an executive team baked into their operations. I have had several class mates in the past 2 years step out and start their own or bought an existing and it’s going okay for them. I have a year or two left of DSO due to some family obligations and then I plan to buy or possibly do a start up.

DSO is not a bad place to start but I think if you’re going to work full time it makes sense to have equity in an office.

edit: I had similar loans to you and paid them off in three years. Focus on being debt free ASAP and you will have a lot of opportunities available to you.

Exploited is a tough swallow. The vast majority of working people are employees for small, medium and large companies. Are they all being exploited? Some companies are terrible. Others are not. There was a time when large companies took care of their employees. Mayby not the case anymore. I agree that the unique thing about dentistry is that it allows you to be an owner or employee. But make no mistake. Being an owner is not for everyone. There is real freedom in being an employee also. If your ship is going down ..... employees can jump ship and look for a better one. Owner goes down with their ship.

That said. I firmly believe that ownership is the right path. Maybe in combination with being "exploited" at a DSO part time. Choose a rural/semi rural area and you should be a practice owner period.

At the DSO I work at there are two types of dentists. Recent grads who don't last long and us older guys. I rarely see middle aged dentists in their prime working at the DSO I'm at. There are a few middle aged dentists there who started as a grad or couldn't make it with practice ownership. They make decent money, but they always have that look of ......... what could have been.

 

[yappy]

Exploited is a tough swallow. The vast majority of working people are employees for small, medium and large companies. Are they all being exploited?

 

[charlestweed]

A lot of dentists from other countries want to come to the US to work for DSO’s. They’d rather be “exploited” here in the US than staying in their home countries. Some of them couldn’t get dental license and have to work as dental assistants or teach at dental schools. They make more (and have a happier life) working as dental assistants here in the US than staying in their home countries. As an owner, your goal should be to pay your employees as little as possible or to hire as few employees as possible so you can maximize the profit. Many dental practices (especially the ones that are owned by older dentists) fail because they have overpaid staff and high overhead. Capitalism is not perfect but it’s the best out there. Capitalism creates jobs. And jobs provide dignity and purpose.

 

[2TH MVR]

A lot of dentists from other countries want to come to the US to work for DSO’s. They’d rather be “exploited” here in the US than staying in their home countries. Some of them couldn’t get dental license and have to work as dental assistants or teach at dental schools. They make more (and have a happier life) working as dental assistants here in the US than staying in their home countries. As an owner, your goal should be to pay your employees as little as possible or to hire as few employees as possible so you can maximize the profit. Many dental practices (especially the ones that are owned by older dentists) fail because they have overpaid staff and high overhead. Capitalism is not perfect but it’s the best out there. Capitalism creates jobs. And jobs provide dignity and purpose.

I imagine the AFL-CIO worker's union won't be inviting you to speak to the members any time soon.

 

[charlestweed]

I imagine the AFL-CIO worker's union won't be inviting you to speak to the members any time soon.

LOL. I remember when I worked as a busboy at one of the Disneyland’s restaurants during my HS and college years; a portion of my paycheck was automatically deducted for union due. And the union didn’t do squat for me….complete waste of my hard earned money.

My office manager is the only person who deserves to get paid well. She handles the every day operation including case presentations (selling), insurance billings, payment collections etc. The office can’t function without her. She’s the only person whom I can trust to handle my money. She gets bonuses, sick pays, holiday pays, and 401k. Everyone else in my office can be replaced. It’s supply and demand. Stay if they like my pay offers and quit if they don’t.

Keep the business operation system as simple as possible so you won’t need to hire a lot of employees. When I look at some the ortho websites and see the owner doctors who are taken pictures with a large group of 5-10 staff members, I often wonder why do they have to hire so many employees….the overhead must be crazily high. My website doesn’t have such photo because I only have 2 F/T employees (used to be 3). The rest of them are part time assistants who only come to work on the days (11 days/month) that we see patients.

 

[2TH MVR]

LOL. I remember when I worked as a busboy at one of the Disneyland’s restaurants during my HS and college years; a portion of my paycheck was automatically deducted for union due. And the union didn’t do squat for me….complete waste of my hard earned money.

My office manager is the only person who deserves to get paid well. She handles the every day operation including case presentations (selling), insurance billings, payment collections etc. The office can’t function without her. She’s the only person whom I can trust to handle my money. She gets bonuses, sick pays, holiday pays, and 401k. Everyone else in my office can be replaced. It’s supply and demand. Stay if they like my pay offers and quit if they don’t.

Keep the business operation system as simple as possible so you won’t need to hire a lot of employees. When I look at some the ortho websites and see the owner doctors who are taken pictures with a large group of 5-10 staff members, I often wonder why do they have to hire so many employees….the overhead must be crazily high. My website doesn’t have such photo because I only have 2 F/T employees (used to be 3). The rest of them are part time assistants who only come to work on the days (11 days/month) that we see patients.

Oh. I agree with you. My practices were those 3000-4000 sq ft dinosaurs with the bloated staffs and their high salaries. During the good ole yrs .... I even took them to the AAO meetings in Hawaii, San Francisco, LA, San Diego. Profit sharing plans, health insurance, 3 week vacations, PTO, sick days, etc. etc. I could afford the high overhead since I was making plenty of money.

Had I decided to stay in private practice ..... I would have followed your direction. Streamlined my entire practice to be smaller and more efficient. Do I have regrets from not attempting to change my practices? Not at all. Been there. Done that. Time for something different. I actually enjoy the freedom of working for a DSO. Works for myself in my situation.

 

[charlestweed]

Oh. I agree with you. My practices were those 3000-4000 sq ft dinosaurs with the bloated staffs and their high salaries. During the good ole yrs .... I even took them to the AAO meetings in Hawaii, San Francisco, LA, San Diego. Profit sharing plans, health insurance, 3 week vacations, PTO, sick days, etc. etc. I could afford the high overhead since I was making plenty of money.

Yeah, I would have done the same as what you did if I were in a less saturated area. When I started my office in 2006, there were already corp and private ortho offices everywhere. With over $1 million in debt (student, home, my wife's practice loans + 2 leased cars), I couldn't afford to borrow another $3-400k loan to build a practice and no bank would want to lend me that much amount money either. I went to a smaller no name bank and was able to get a $70k loan. And I had $55k emergency fund in my saving account. Everyone's situation is different. My situation forced me to start small. I am glad that I had worked for the corp for a few years before I opened my own office. With the experience I gained from working at the corp, I knew exactly what I needed to buy and what I didn't need to waste my money on. If I was a clueless new grad, who had zero work experience and tried to open a practice from scratch, I would have spent a lot of money on uncessary things..

Had I decided to stay in private practice ..... I would have followed your direction. Streamlined my entire practice to be smaller and more efficient. Do I have regrets from not attempting to change my practices? Not at all. Been there. Done that. Time for something different. I actually enjoy the freedom of working for a DSO. Works for myself in my situation.

That's the beauty of our profession. You won't get laid off like many middle aged engineers around the country. If you don't want to completely retire (because it's boring to stay home doing nothing every day) and don't want to deal with the headaches of running your own office 5 days/wk, you can work 1-2 days a week for the corp and still be able to bring home a 6-figure income....and still be able to enjoy many outdoor activities.

 

[gryffindor]

Keep the business operation system as simple as possible so you won’t need to hire a lot of employees. When I look at some the ortho websites and see the owner doctors who are taken pictures with a large group of 5-10 staff members, I often wonder why do they have to hire so many employees….the overhead must be crazily high. My website doesn’t have such photo because I only have 2 F/T employees (used to be 3). The rest of them are part time assistants who only come to work on the days (11 days/month) that we see patients.

Around here, the part-time "work the days we see patients" are not a polished, experienced set of staff. They are a ragtag crew of people looking for experience. And if they are good but only working part-time, it's because they have other goals (dental hygienist, dental school, etc.) so they're not going to be around for too long. The good staff with experience have full time jobs. For clinical positions, they can negotiate and command higher salaries because there is such a shortage. With full time staff, I know they are dedicated to just this one job and less likely to jump around. And as I've grown, I realized that the redundancy in each position helps because staff are going to be out for things like maternity leaves, sick kids, vacations, and now COVID exposures and quarantines.

I'm about to add my 4th full timer. A year ago, I only had 2 full timers. I just had 1 front staff return from maternity leave last month only to learn this week that the other front staff is pregnant. The full time clinical assistant in the back is out on vacation and with the quarantine rules, she's out for 3 weeks. I've realized that I need another full time person in the back because the part-time crew just fails at filling in the holes when the full timers are gone. And although my patient base is very forgiving and not high maintenance, we've grown because we give them great service and the best way to do this has been to build a present and available team.

My post has nothing to do with teeth and everything to do with building a business. I never realized when I was in school that I would have the opportunity to be a business owner as one aspect of my dental career and I'm enjoying it along the way.

 

[charlestweed]

Around here, the part-time "work the days we see patients" are not a polished, experienced set of staff. They are a ragtag crew of people looking for experience. And if they are good but only working part-time, it's because they have other goals (dental hygienist, dental school, etc.) so they're not going to be around for too long. The good staff with experience have full time jobs. For clinical positions, they can negotiate and command higher salaries because there is such a shortage. With full time staff, I know they are dedicated to just this one job and less likely to jump around. And as I've grown, I realized that the redundancy in each position helps because staff are going to be out for things like maternity leaves, sick kids, vacations, and now COVID exposures and quarantines.

I'm about to add my 4th full timer. A year ago, I only had 2 full timers. I just had 1 front staff return from maternity leave last month only to learn this week that the other front staff is pregnant. The full time clinical assistant in the back is out on vacation and with the quarantine rules, she's out for 3 weeks. I've realized that I need another full time person in the back because the part-time crew just fails at filling in the holes when the full timers are gone. And although my patient base is very forgiving and not high maintenance, we've grown because we give them great service and the best way to do this has been to build a present and available team.

My post has nothing to do with teeth and everything to do with building a business. I never realized when I was in school that I would have the opportunity to be a business owner as one aspect of my dental career and I'm enjoying it along the way.

All of my P/T assistants are good and fast because, unlike the ones who work at private practices, they work full time for the corp offices and they get used to the busy schedule. Many of them currently work with me at the corp and they know my treatment style. They can multitask (taking xray, taking and pouring impressions, making and delivering retainers etc. I don’t need to train any of them….they are ready to work for me on day one. I don’t just pick anyone at the corp; I cherry-pick the fast ones. Some of my P/T assistants refer their assistant friends to me and they only refer the fast ones to me because nobody wants to work with a slow one, who may cause the entire team to go home late.

One of the advantages of opening my offices on the weekends is it’s easier for me to get these P/T assistants to come work for me because they have to work full time for the corps on the weekdays. On the weekdays, I can only get 2-3 P/T assistants (and that should be plenty of help for 50-60 patients) but on the weekends I can get 5-6 P/T assistants. They all love working at my offices because they only have to work for 4 hours and get paid $160-180.

 

[gryffindor]

All of my P/T assistants are good and fast because, unlike the ones who work at private practices, they work full time for the corp offices and they get used to the busy schedule. Many of them currently work with me at the corp and they know my treatment style. They can multitask (taking xray, taking and pouring impressions, making and delivering retainers etc. I don’t need to train any of them….they are ready to work for me on day one. I don’t just pick anyone at the corp; I cherry-pick the fast ones. Some of my P/T assistants refer their assistant friends to me and they only refer the fast ones to me because nobody wants to work with a slow one, who may cause the entire team to go home late.

One of the advantages of opening my offices on the weekends is it’s easier for me to get these P/T assistants to come work for me because they have to work full time for the corps on the weekdays. On the weekdays, I can only get 2-3 P/T assistants (and that should be plenty of help for 50-60 patients) but on the weekends I can get 5-6 P/T assistants. They all love working at my offices because they only have to work for 4 hours and get paid $160-180.

I have one part-timer out this week due to exposure to COVID. I was lucky my associate was able to convince one of the experienced assistants at her other job to come and temp otherwise I would have to cancel an entire column of patients. I paid her $220 cash which is just a few dollars above what she makes at her regular assistant job. (The one who was out with the COVID exposure is a college student that's been with me since high school and would have made around $100 pre-tax.) We don't have a ton of corp offices in general in my state compared to what I read about places like Texas and California. The one corp near me always has an ad up looking for an ortho assistant and I've heard through the grapevine that people generally don't like working for that office.

I think you are very lucky to have established your style of practice. It would be hard for a new graduate to duplicate.

 

[2TH MVR]

I think you are very lucky to have established your style of practice. It would be hard for a new graduate to duplicate.

I'm not sure he was lucky. I believe that was his ONLY way to succeed in such a saturated city. Low fee economics. Phoenix is essentially the same as LA. There are tons of dentists and orthos and CORPS are everywhere. Within the last 10 -15 yrs two medium sized Corps: Risas Dental and Somos Dental have taken CharlesTweeds low fee formula to the extreme. They cater directly to the hispanic population with LOW FEES. They are taking a huge bite out of the Corp that I work for since we are not low fee. They have these modern facilities, but everything is based on low fees and volume (which goes hand in hand). I'll let you decide on the quality of the treatment. Their fees are roughly 1/2 our fees.

Lucky is being in an area with few Corps.

 

[Molar Whisperer]

All of my P/T assistants are good and fast because, unlike the ones who work at private practices, they work full time for the corp offices and they get used to the busy schedule. Many of them currently work with me at the corp and they know my treatment style. They can multitask (taking xray, taking and pouring impressions, making and delivering retainers etc. I don’t need to train any of them….they are ready to work for me on day one. I don’t just pick anyone at the corp; I cherry-pick the fast ones. Some of my P/T assistants refer their assistant friends to me and they only refer the fast ones to me because nobody wants to work with a slow one, who may cause the entire team to go home late.

One of the advantages of opening my offices on the weekends is it’s easier for me to get these P/T assistants to come work for me because they have to work full time for the corps on the weekdays. On the weekdays, I can only get 2-3 P/T assistants (and that should be plenty of help for 50-60 patients) but on the weekends I can get 5-6 P/T assistants. They all love working at my offices because they only have to work for 4 hours and get paid $160-180.

A lot of dentists from other countries want to come to the US to work for DSO’s. They’d rather be “exploited” here in the US than staying in their home countries. Some of them couldn’t get dental license and have to work as dental assistants or teach at dental schools. They make more (and have a happier life) working as dental assistants here in the US than staying in their home countries. As an owner, your goal should be to pay your employees as little as possible or to hire as few employees as possible so you can maximize the profit. Many dental practices (especially the ones that are owned by older dentists) fail because they have overpaid staff and high overhead. Capitalism is not perfect but it’s the best out there. Capitalism creates jobs. And jobs provide dignity and purpose.

I like to learn your secret to paying your staff "as little as possible" and still assemble the dream team with their referrals. I don't own a clinic and I don't pay my DAs. In my state, we have a shortage of DAs. I'm fortunate that my lead DA followed me from 2 previous locations. My other DA was one that no dentist at my current clinic wanted. She's still with me while many other DAs left. I have the ultimate dream team where we keep most schedules efficient and low stress. Many times we keep our schedules too efficient since we get emergencies and walk ins from other clinics and providers.

At the DSO I work at there are two types of dentists. Recent grads who don't last long and us older guys. I rarely see middle aged dentists in their prime working at the DSO I'm at. There are a few middle aged dentists there who started as a grad or couldn't make it with practice ownership. They make decent money, but they always have that look of ......... what could have been.

Granted I'm the middle aged dentist who couldn't make it with practice ownership and maybe I have "that look of ........... what could have been." At least my family, staff, and patients aren't ashamed of me (to my knowledge. It would feel very awkward if they did).

 

[charlestweed]

I have one part-timer out this week due to exposure to COVID. I was lucky my associate was able to convince one of the experienced assistants at her other job to come and temp otherwise I would have to cancel an entire column of patients. I paid her $220 cash which is just a few dollars above what she makes at her regular assistant job. (The one who was out with the COVID exposure is a college student that's been with me since high school and would have made around $100 pre-tax.) We don't have a ton of corp offices in general in my state compared to what I read about places like Texas and California. The one corp near me always has an ad up looking for an ortho assistant and I've heard through the grapevine that people generally don't like working for that office.

I think you are very lucky to have established your style of practice. It would be hard for a new graduate to duplicate.

I currently have 8 P/T assistants but I only need 3-5 of them (depending on how busy the schedule is) to come in to help me. Two of them only work for me 1 day/month. The one, who works for me the most days, works 6 days/month. If one of them can’t work on his/her assigned day, I can easily ask another person to sub.

I am very fortunate that my 2 F/T employees have never called in sick nor taken vacation. Even during the mandatory Covid shutdown, both of them continued to show up for work. They helped taking care of the emergencies (cutting poky wires, loose brackets etc). They didn’t file for unemployment despite their hours were reduced to 32 hours/wk (from the usual 40-45hrs/wk). This pandemic helped me realize how loyal these 2 employees are to me. Many of my friends’ staff didn’t come back to work because of the large unemployment checks that they collected from the Federal government.

Most private practice assistants are spoiled and too slow. They only stay at 1 chair and not jump from chair to chair like the corp assistants. When they quit PP to join the corp, they can't survive the fast pace at the corp. They make too many clinical mistakes and have to be let go.

 

[charlestweed]

I'm not sure he was lucky. I believe that was his ONLY way to succeed in such a saturated city. Low fee economics. Phoenix is essentially the same as LA. There are tons of dentists and orthos and CORPS are everywhere. Within the last 10 -15 yrs two medium sized Corps: Risas Dental and Somos Dental have taken CharlesTweeds low fee formula to the extreme. They cater directly to the hispanic population with LOW FEES. They are taking a huge bite out of the Corp that I work for since we are not low fee. They have these modern facilities, but everything is based on low fees and volume (which goes hand in hand). I'll let you decide on the quality of the treatment. Their fees are roughly 1/2 our fees.

Lucky is being in an area with few Corps.

Low fee alone is not enough. In order for the practice to thrive, you need to have a long track record of providing good clinical results. Word-of-mouth referral is very important. The clinical results are not only judged by the patients but by their general dentists as well. GP referral is also important. When the new patient is referred to us by one of our patients, we don’t have to make any effort to “sell” ….and the patient usually starts treatment the same day. Low fees don’t necessarily equate to low quality work. Treatment outcomes depend on the doctor's clinical experience. To many patients, Low Fees = Honesty…..no RPE on every patient….no phase I treatment BS.

 

[charlestweed]

I like to learn your secret to paying your staff "as little as possible" and still assemble the dream team with their referrals. I don't own a clinic and I don't pay my DAs. In my state, we have a shortage of DAs. I'm fortunate that my lead DA followed me from 2 previous locations. My other DA was one that no dentist at my current clinic wanted. She's still with me while many other DAs left. I have the ultimate dream team where we keep most schedules efficient and low stress. Many times we keep our schedules too efficient since we get emergencies and walk ins from other clinics and providers.

I actually pay my P/T assistants very well. They get paid $160-180 for working only 4 hours a day (8am-12 noon). The benefit is mutual. The assistants already have F/T job at the corp. So working part time for me is like having a 2nd weekend job as an uber driver. And the benefit for me is I save a lot in overhead for NOT having to hire a lot of F/T employees. For ortho, you don't need to open your office 5 days/week. You can book 60-100 patients in one day and only need to work a few days a month. And you only need P/T assistants to work for you on those few days in a month.

 

[gryffindor]

I'm not sure he was lucky. I believe that was his ONLY way to succeed in such a saturated city. Low fee economics. Phoenix is essentially the same as LA. There are tons of dentists and orthos and CORPS are everywhere. Within the last 10 -15 yrs two medium sized Corps: Risas Dental and Somos Dental have taken CharlesTweeds low fee formula to the extreme. They cater directly to the hispanic population with LOW FEES. They are taking a huge bite out of the Corp that I work for since we are not low fee. They have these modern facilities, but everything is based on low fees and volume (which goes hand in hand). I'll let you decide on the quality of the treatment. Their fees are roughly 1/2 our fees.

Lucky is being in an area with few Corps.

That's rough with those corps coming in with that approach. What is your corp doing in response?

I can't imagine any of the younger orthos that I have met along the way would open a practice like charlestweed. The staff shortage alone makes it very challenging to operate here if you open from scratch. One of the younger startup doctors called recently for advice on lowering lab fees since sending for scanned appliances is pricey if you're not charging high enough to be compensated for it. I gave a number of suggestions including doing your own lab work while you are not busy (I did my own for a while when I opened) but I'm certain this doctor wasn't going to do that. Another doctor said he wasn't going to stock bands, everything would be scanned and 3D printed. Yes I know that is the future and I think old-school techniques that we may have learned that helped keep costs low for prior generations of dentists aren't even options for new grads anymore. Stuff like using paper charts, doing your own lab work, figuring out analog ways of doing things when the digital fails, etc.

 

[2TH MVR]

Low fee alone is not enough. In order for the practice to thrive, you need to have a long track record of providing good clinical results. Word-of-mouth referral is very important. The clinical results are not only judged by the patients but by their general dentists as well. GP referral is also important. When the new patient is referred to us by one of our patients, we don’t have to make any effort to “sell” ….and the patient usually starts treatment the same day. Low fees don’t necessarily equate to low quality work. Treatment outcomes depend on the doctor's clinical experience. To many patients, Low Fees = Honesty…..no RPE on every patient….no phase I treatment BS.

I was referring to these low fee Corps .... not you. The difference is that YOU can control your quality, but can a medium or large Corp with low fees control their quality with all their moving parts? You've developed a niche with your patients and referring dentists. Good treatment at a reasonable price. Win-win for you and the patients.

 

[2TH MVR]

That's rough with those corps coming in with that approach. What is your corp doing in response?

I can't imagine any of the younger orthos that I have met along the way would open a practice like charlestweed.

The Corp I work for is a dinosaur. An older Corp that used to have little competition. If anything .... they have RAISED their ortho fees. The result is we are starting fewer ortho pts. I give my employer cred for having the kahunas to raise our fees. But the Corp as a whole needs to re-evaluate it's direction. Right now .... it's direction is to EXPAND into other states. Acquire other smaller Corp entities. I guess all this expansion looks good for the hedge fund owners.

I don't really care about the Corp's direction since I am just an employee. I could jump ship if I needed to. Somos Dental and another large Corp have already offered me a job. But I'm sticking put.

Right now ..... our fees are high and that means less patients are seen in a single day. I see about 40-60 patients a day. Somos Dental/ Risas Dental see around a 100 patients a day. They literaly need to see twice as many patients a we do to make the SAME money. Fewer patient means I can spend more time on their treatment. Sure. I probably make less money than the orthos working at these low fee factories, but at this point in my career .... it's not about the money.


As for the younger orthos. Yeah. I don't see them working like CharlesTweed. Oh Charles is about as analog as you can get.

 

[Cold Front]

I probably make less money than the orthos working at these low fee factories, but at this point in my career .... it's not about the money.

Some dentists are worried about how much money they can make, but sooner or later, we will all worry about how much time we have left.

We have to meet one of the days with Charles, and help him publish “Hardwork for Dummies - The official guide for weak dentists who like to complain. Volume 1” lol

 

[PerioDont]

Some dentists are worried about how much money they can make, but sooner or later, we will all worry about how much time we have left.

We have to meet one of the days with Charles, and help him publish “Hardwork for Dummies - The official guide for weak dentists who like to complain. Volume 1” lol

me and I'm sure many others on here are paying attention! We are not all eating avocado toast and scrolling Instagram

Work hard, be a practice owner ASAP, minimize debt and live under your means seems to be the key to success

 

[charlestweed]

I was referring to these low fee Corps .... not you. The difference is that YOU can control your quality, but can a medium or large Corp with low fees control their quality with all their moving parts? You've developed a niche with your patients and referring dentists. Good treatment at a reasonable price. Win-win for you and the patients.

I knew you were referring to the low fee corps. My point was low fees and high patient volume don’t necessarily mean low quality work. What if these low fee corps hire orthodontists who have very good clinical experience and can easily handle 100+ patients a day? What if these low fee corps have very good assistants? You can still have poor clinical results in offices that are not busy because the treating doctors don’t have good clinical experience and judgments. In ortho, correct diagnosis and tx plan yield good clinical results. This is the reason why our field can never be replaced by AI. For good clinical results, an orthodontist has to be present at the office to monitor the progress of the ortho tx and make tx decisions every month.

 

[charlestweed]

As for the younger orthos. Yeah. I don't see them working like CharlesTweed. Oh Charles is about as analog as you can get.

You are right. The new grads can’t work like me. It’s like asking them to go back to use gold foil to fill a tooth. Even the ones, who graduated the same time with me, can’t work like me either. Most orthodontic offices go digital. Sadly, technology does more harm than good for both doctors and patients.

For doctors: Significant increase in overhead. More time wasted to learn how to operate (and to repair) these modern equipments. The staff become dependent on these machines and lose the ability to multitask. Doctor’s stress level increases when these machines stop working .

For patients: Increase in doctors’ overhead means increase in tx cost for the patients. Since equipments are linked together, if one of them fails to work, the whole system fails…. and patients have to be rescheduled. Paper charts are much more efficient and they never break down.

I invited a few young orthodontists and ortho residents from this SDN and orthotown forums to my offices to see how I treat patients with paper charts and low tech equipments. I thought they would learn from their visits. But when they went back to their home towns and set up their practices, they couldn’t quite replicate my way. They ended up spending way too much money on their offices.

 

[gryffindor]

What if these low fee corps hire orthodontists who have very good clinical experience and can easily handle 100+ patients a day? What if these low fee corps have very good assistants?

I feel that these qualities in doctors and assistants are hard to find in general, let alone finding this combination of unicorns working at a corporation. It's possible, but we both know that the majority of corp ortho coming out is not high quality due to situations beyond the doctor's control - poor scheduling, ineffective front desk, lost information, limited clinical resources, etc. And that can be a stressful work environment to produce quality results when so much is out of your control.

 

[gryffindor]

For doctors: Significant increase in overhead. More time wasted to learn how to operate (and to repair) these modern equipments. The staff become dependent on these machines and lose the ability to multitask. Doctor’s stress level increases when these machines stop working .

For patients: Increase in doctors’ overhead means increase in tx cost for the patients. Since equipments are linked together, if one of them fails to work, the whole system fails…. and patients have to be rescheduled. Paper charts are much more efficient and they never break down.

I have to disagree on the paper charts. I trained in the era of paper charts right before digital happened. I don't miss those at all. At one office where I was a long term temp, it was so hard to read the handwriting of the other ortho's notes. I bought special pens to write legible notes in very tiny letters because there wasn't enough room to record those bad situations when you need to write the CYA details. And there were a lot of CYA situations as this was a high maintenance population that was already mad that they were seeing me and not the other doctor who was out with an illness. That doctor finally went digital about 4 few years later. At another office, the charts were constantly lost. At a third office, there was a student whose sole job after school was to pull the charts for the next day and file all the other ones back. At my GPR, the charts were these huge thick binders that were like 3" thick and it was so hard to find the info you needed on your patient. I remember having to go down to "Medial Records" in dental school to nicely ask the ladies who worked there to please pull the charts on some patient that had been archived. Entire rooms and files cabinets were dedicated to storing the charts.

Digital charts are really amazing by comparison. There are reasonably priced solutions, and then there are the programs that charge an arm and a leg.

 

[cmsmith85]

Right now ..... our fees are high and that means less patients are seen in a single day. I see about 40-60 patients a day. Somos Dental/ Risas Dental see around a 100 patients a day. They literaly need to see twice as many patients a we do to make the SAME money.

I'm a GP with Risas and can at least attest to the work our orthodontist does. He's fantastic and takes his time with each patient. He usually sees around 90-95 patients a day, but that's during an 11 hour work day with 6 columns and assistants. So that's like seeing around 70 patients a day if you're working a normal 8 hour day. We all work three 11 hour work days, so it's not like the orthodontists are seeing 500 patients a week.

 

[2TH MVR]

I have to disagree on the paper charts. I trained in the era of paper charts right before digital happened. I don't miss those at all. At one office where I was a long term temp, it was so hard to read the handwriting of the other ortho's notes. I bought special pens to write legible notes in very tiny letters because there wasn't enough room to record those bad situations when you need to write the CYA details. And there were a lot of CYA situations as this was a high maintenance population that was already mad that they were seeing me and not the other doctor who was out with an illness. That doctor finally went digital about 4 few years later. At another office, the charts were constantly lost. At a third office, there was a student whose sole job after school was to pull the charts for the next day and file all the other ones back. At my GPR, the charts were these huge thick binders that were like 3" thick and it was so hard to find the info you needed on your patient. I remember having to go down to "Medial Records" in dental school to nicely ask the ladies who worked there to please pull the charts on some patient that had been archived. Entire rooms and files cabinets were dedicated to storing the charts.

Digital charts are really amazing by comparison. There are reasonably priced solutions, and then there are the programs that charge an arm and a leg.

I have to agree. No way I go back to paper charts. The CYA issue is real. Need to document EVERYTHING nowadays and it needs to be legible. In order to be efficient .... I do alot of cut and paste to document procedures.

I get where Charles is coming from though. I used to have 2 locations with 2 servors and an internet connection. Not really modern with today's cloud stuff. But I had SEVERAL hacking/virus issues even though I had an IT company helping. Extremely stressful when all your data is digital.

The Corp I'm employed at has it's own proprietary private software and a team of IT people. It's very intuitive and I could not imagine not having the digital capability. One of the Corps that was trying to lure me away from my current employer still has paper charts. I said no way. I believe they are trying to go digital,

But again. If you're Charles ...... in order for him to be successful with his practice model (low fees) .... EVERYTHING has to be simple and inexpensive. And it obviously works for him.

I feel that these qualities in doctors and assistants are hard to find in general, let alone finding this combination of unicorns working at a corporation. It's possible, but we both know that the majority of corp ortho coming out is not high quality due to situations beyond the doctor's control - poor scheduling, ineffective front desk, lost information, limited clinical resources, etc. And that can be a stressful work environment to produce quality results when so much is out of your control.

Agree in most part, but what I have seen is mostly laziness on the part of the orthos. Most of them know they won't be there for the long term .... so they just "kick the can down the road" for the next orthodontist. You know. Retie. Power chain. Rinse and repeat. With the patient not progressing forward.

The other part is that some of them are just plain bad. Some are new grads that are still learning. I give them a pass. The veterans though. No excuse.
It pisses me off when patients have paid good money for a service only to have a terrible result. Not even average, but terrible.

 

[2TH MVR]

I'm a GP with Risas and can at least attest to the work our orthodontist does. He's fantastic and takes his time with each patient. He usually sees around 90-95 patients a day, but that's during an 11 hour work day with 6 columns and assistants. So that's like seeing around 70 patients a day if you're working a normal 8 hour day. We all work three 11 hour work days, so it's not like the orthodontists are seeing 500 patients a week.

That's good to hear. I've heard about the 11 hr work days. No thanks.

 

[cmsmith85]

That's good to hear. I've heard about the 11 hr work days. No thanks.

Haha yeah, it's not for the faint of heart. Takes a good while to get used to and is honestly a little brutal on the body. At least for GPs it is.

 

[charlestweed]

I feel that these qualities in doctors and assistants are hard to find in general, let alone finding this combination of unicorns working at a corporation. It's possible, but we both know that the majority of corp ortho coming out is not high quality due to situations beyond the doctor's control - poor scheduling, ineffective front desk, lost information, limited clinical resources, etc. And that can be a stressful work environment to produce quality results when so much is out of your control.

Corps actually attract a lot of good orthodontists and assistants because 1. They pay better than private practices (PP). 2. They offer more work days (F/T job) for orthodontists and assistants because they have more offices and more patients. 3. They offer more benefits (401k, health insurance, malpractice insurance etc) than PP. 4. The orthodontists have full autonomy. Unlike PP, there is no owner doctor above them telling them what to do.

Not all corps are bad. Many of their legal forms are written by very good lawyers. They make sure their employees adhere to strict OSHA/infection control rules. Insurance companies send people to corp offices to audit charts every year; therefore, the doctors are forced to be more careful with the chart documentations. Many doctors have worked there for a long time and have produced good clinical results. They are super-efficient (because of the experience they gain from tx high patient volume) and have excellent chair time management skill. Assistants are fast because the slow ones usually get fired after the trial period. It usually takes my corp assistants under 10 minutes to fit/cement 4 molar bands. Some slow ones, who were from PP, spent more than an hour and still couldn’t get things done correctly.

There are a lot of misconceptions about corp offices, which have dissuaded a lot of new grads from working for them. Just ask DEEP IMPACT….he is an Oral Surgeon, who recently joined the corp and he has been very happy with the decision. He didn’t want to work for the corp offices before because he had heard a lot of bad things about them (from his colleagues) which he later found out were untrue.

 

[charlestweed]

I have to disagree on the paper charts. I trained in the era of paper charts right before digital happened. I don't miss those at all. At one office where I was a long term temp, it was so hard to read the handwriting of the other ortho's notes. I bought special pens to write legible notes in very tiny letters because there wasn't enough room to record those bad situations when you need to write the CYA details. And there were a lot of CYA situations as this was a high maintenance population that was already mad that they were seeing me and not the other doctor who was out with an illness. That doctor finally went digital about 4 few years later. At another office, the charts were constantly lost. At a third office, there was a student whose sole job after school was to pull the charts for the next day and file all the other ones back. At my GPR, the charts were these huge thick binders that were like 3" thick and it was so hard to find the info you needed on your patient. I remember having to go down to "Medial Records" in dental school to nicely ask the ladies who worked there to please pull the charts on some patient that had been archived. Entire rooms and files cabinets were dedicated to storing the charts.

Digital charts are really amazing by comparison. There are reasonably priced solutions, and then there are the programs that charge an arm and a leg.

Just like you said before…not a lot of docs can work like me. I love paper charts. The entire 2 yr tx can be viewed in one double-sided page. I have 800 active patients (all 4 offices combined). What’s so hard about maintaining paper charts and keeping track of payments for only 800 active patients? It’s not rocket science. As soon as the treatment is completed, the chart is placed in a separate “retention” file cabinet and remains in there for 2-3 years. After 2-3 years, it is then moved to the storage room in the back. That’s what my 2 F/T employees are there for ….and not to sit around doing nothing on non-clinic days (11 days/month).

 

[gryffindor]

Just like you said before…not a lot of docs can work like me. I love paper charts. The entire 2 yr tx can be viewed in one double-sided page. I have 800 active patients (all 4 offices combined). What’s so hard about maintaining paper charts and keeping track of payments for only 800 active patients? It’s not rocket science. As soon as the treatment is completed, the chart is placed in a separate “retention” file cabinet and remains in there for 2-3 years. After 2-3 years, it is then moved to the storage room in the back. That’s what my 2 F/T employees are there for ….and not to sit around doing nothing on non-clinic days (11 days/month).

No it's not rocket science but it's a people management challenge. As an owner you have to assume the person you just hired for $12, $15, $19/hour knows almost nothing. I have to make the job as simple as possible so they don't screw things up and make more work for me. Running and posting hundreds of automated payments with 1 click on software is one way to do that and decrease errors versus tackling each payment individually.

Same logic goes for buying a scanner, a purchase I resisted for a long time because it's so easy to take an alginate. But it's so hard to teach a newbie how to take a good alginate consistently. Much much easier to teach a newbie how to scan. My lab now charges a very reasonable fee to print the models. I did the math and it's about the same to scan and purchase printed models vs the wages it will cost to take an impression, cleanup the chair and bowls, pour, and trim the model assuming I have someone skilled enough to do those steps without screwing one of the steps up along the way. Right now I'm operating on the assumption that I don't have talented staff, and technology has been a really good substitute.

Yes, one could start with paper charts and an old school appointment book and then buy the software once the office gets busy enough. That's not a bad way to save some money for at least that first year when you're probably not that busy. Same goes for the scanner. Some will do it and add the luxuries as they grow, some won't and want everything from day 1 and the loan payments to go with it.

 

[gryffindor]

I get where Charles is coming from though. I used to have 2 locations with 2 servors and an internet connection. Not really modern with today's cloud stuff. But I had SEVERAL hacking/virus issues even though I had an IT company helping. Extremely stressful when all your data is digital.

I'm at home accessing my software just like those in the office. It usually works very well and has improved over the 10 years I've been using the software. IT issues are real and just another one of the stresses of running a business. However, this is one area where technology has just made our lives better. I'm going to do a long list of treatment plans that my staff are waiting on to submit various insurance things. It's nice to have the ability to do it at home and not have to commute 45 minutes to the office.

There's good and bad coming out of corps and private practice. I agree private practice has done a terrible job in providing desirable employment opportunities for our younger colleagues. You mentioned this earlier with your experiences when you graduated. I experienced similarly. Corps took advantage and sprung up and filled a void in many areas.

 

[charlestweed]

No it's not rocket science but it's a people management challenge. As an owner you have to assume the person you just hired for $12, $15, $19/hour knows almost nothing. I have to make the job as simple as possible so they don't screw things up and make more work for me. Running and posting hundreds of automated payments with 1 click on software is one way to do that and decrease errors versus tackling each payment individually.

Same logic goes for buying a scanner, a purchase I resisted for a long time because it's so easy to take an alginate. But it's so hard to teach a newbie how to take a good alginate consistently. Much much easier to teach a newbie how to scan. My lab now charges a very reasonable fee to print the models. I did the math and it's about the same to scan and purchase printed models vs the wages it will cost to take an impression, cleanup the chair and bowls, pour, and trim the model assuming I have someone skilled enough to do those steps without screwing one of the steps up along the way. Right now I'm operating on the assumption that I don't have talented staff, and technology has been a really good substitute.

Yes, one could start with paper charts and an old school appointment book and then buy the software once the office gets busy enough. That's not a bad way to save some money for at least that first year when you're probably not that busy. Same goes for the scanner. Some will do it and add the luxuries as they grow, some won't and want everything from day 1 and the loan payments to go with it.

I know what you were saying. A lot of assistants claimed they had a lot of experience during the job interviews. But when they join your team, you soon realize that they know almost nothing. Here in CA, we have a surplus of ortho assistants who are desparate for work because a lot of offices (PP and corp offices) don't give them enough work days. Corps usually give them more days but still less than 40 hours a week. Paying my P/T employee $160-180 a day, 4-5 days/month is still much less than paying a F/T employee $12 hrs/day, 22 days/month. And my P/T employees are very good. With alginate, we can take impressions on multiple patients at the same time and not have to rely on 1 scanner. It's not uncommon for us to have starts and final debonds at the same time.

The reason I keep everything low tech is I don't want my 2 F/T employeees to sit around doing nothing, especially on the days we don't see patients. I have to create more work to keep them busy. Yes, my original intention was to start with low cost paper charts first (because I got used to working with paper charts at the corp) and planned to upgrade to digital later. But now (14 years later) with 800 active patients, my staff can still manage everything OK. So I keep everything the same. I don't want to create more headache (for my staff and myself) for having to learn new things.

 

[Molar Whisperer]

I trained in the era of paper charts right before digital happened. I don't miss those at all. At one office where I was a long term temp, it was so hard to read the handwriting of the other ortho's notes. I bought special pens to write legible notes in very tiny letters because there wasn't enough room to record those bad situations when you need to write the CYA details. And there were a lot of CYA situations as this was a high maintenance population that was already mad that they were seeing me and not the other doctor who was out with an illness. That doctor finally went digital about 4 few years later. At another office, the charts were constantly lost. At a third office, there was a student whose sole job after school was to pull the charts for the next day and file all the other ones back. At my GPR, the charts were these huge thick binders that were like 3" thick and it was so hard to find the info you needed on your patient. I remember having to go down to "Medial Records" in dental school to nicely ask the ladies who worked there to please pull the charts on some patient that had been archived. Entire rooms and files cabinets were dedicated to storing the charts.

Digital charts are really amazing by comparison. There are reasonably priced solutions, and then there are the programs that charge an arm and a leg.

I have to agree. No way I go back to paper charts. The CYA issue is real. Need to document EVERYTHING nowadays and it needs to be legible. In order to be efficient .... I do alot of cut and paste to document procedures.

A lot of people here probably have not encountered Board Complaints and legal proceedings like I have. Granted I had one complaint that was investigated and a lawsuit that ended up naming my employer. I still have to report the lawsuit to my yearly insurance credentialing. Electronic records work. If it is down, IT will get it running again and the information will still there. My Board Complaint was when I was using paper charts for the DSO and it was a mess with numerous missing pages. Fortunately the Complaint was on my Hyg who gets production for SRP and Arestin and she probes ~3 mm deeper to justify them. The Complaint was a month after my lawsuit and my attorney advised me to take numerous risk mgt courses and pre-emptively send the Board those certificates to show I'm improving my documentation. After their review, they slapped me with a "Letter of Concern" and the Board investigator was glad I don't work for that DSO anymore.

 

[2TH MVR]

A lot of people here probably have not encountered Board Complaints and legal proceedings like I have. Granted I had one complaint that was investigated and a lawsuit that ended up naming my employer. I still have to report the lawsuit to my yearly insurance credentialing. Electronic records work. If it is down, IT will get it running again and the information will still there. My Board Complaint was when I was using paper charts for the DSO and it was a mess with numerous missing pages. Fortunately the Complaint was on my Hyg who gets production for SRP and Arestin and she probes ~3 mm deeper to justify them. The Complaint was a month after my lawsuit and my attorney advised me to take numerous risk mgt courses and pre-emptively send the Board those certificates to show I'm improving my documentation. After their review, they slapped me with a "Letter of Concern" and the Board investigator was glad I don't work for that DSO anymore.

I hear you brother. Legible, concise, accurate, complete records are the best defense against a board complaint or lawsuit. I've been sued in the past and believe me. You NEVER want to go through that process. I take records and make notes with the attitude that EVERY patient can possibly sue you. That is my rule. If I take over a different office .... all new progress records with a new revised tx plan notated. I NEVER provide extraction referrals even for primary teeth without a full set of diagnostic ortho records. I take PERIAPICALS on EVERY patient along with the regular records. I want to document root anatomy BEFORE I treat them. Most panos are not detailed enough.

I'm always amazed at those dentists (Orthos) at the Corp I'm at that are lazy about taking good records and charting. I can only assume they've never been sued or had a board complaint. I believe I read somewhere that statistically EVERY dentist will be sued once in their lifetime.

I assume every patient I treat to be a possible plaintiff. Not paranoid .... just prepared.