"IF YOU
ARE NOT A DENTAL Student, AND DO NOT EXIT IMMEDIATELY, YOU
WILL BE TURNED INTO A BUDWEISER FROG!" ribbit - ribbit!
"The Biggest Difference between a Great Dentist And an Average Dentist is Good Judgement and ExcellentTreatment Planning!"
"The latest equipment and technology is no greater than the person operating it!"
Quotes by "Doc Hemp"
Updated a little bit more 4/18/06
I don't claim to have any more skill than the majority of all the dentists out there working today. But I do have 38 years of wet fingered dentistry in the trenches and have a lot of experience to offer. All these pages are just my opinions, not necessarily right or wrong ... just the ramblings of an old man that still loves getting up every day and going to an office filled with all the latest technology! Our average staff member has been with us for 26 years or so ... we have the greatest staff and group of patients you will ever find anywhere on the planet! We have fun every day and still manage to do a pretty damn good job too.
Hopefully you can use some of the following insights. No one has all the answers! Use what you can, can what you can't! You can can it can't you? "Use the best ... shine the rest!" "Disagree but .. Don't be a Pest!"
"It is better to walk through your dental career than run or sprint!" "Bigger definitely is not better!" ..."It is BETTER to take your time, do good work, build a wonderful practice, enjoy yourself, your patients & your career!" ...... (Like Dr. Ray Bertolotti says "Better is Better!")
"If you look at each case and base your decision on how much you can make instead of what is best for the patient and their individual circumstances you will grow to hate yourself and your profession." The old saying .. Just do what you would do on yourself in the same situation! .. No more and no less.
"If You Don't Have Time To Do It Right The First Time .... When Will You Have Time To Do It Over?" (author unknown to me)
Let's start with the K.I.S.S. Principle which all of you have already heard of but must always remember! "Keep It Simple Stupid!"
Start out or move to were you want to spend the rest of your life! Not where you THINK you can start off busy in a less desirable place! Building a practice in an area you love is so much more productive and fun! ...It doesn't matter how many dentists are there. There is always room for one more! ... Especially one with a positive attitude "Nothing Ventured .... Nothing Gained! .... The biggest difference between a great practice and an average practice is FEAR! ..... The fear of buying necessary equipment, The fear of moving where we want to live ... The fear of renting that nicer office ... The fear of buying that great practice ... or in other words ... the FEAR to make and follow through with the correct decisions and just make them work!
OVERHEAD .... What does it mean? ... To many it is what keeps you from sucking all the cash you can out of your practice to take home and waste on your toys! ... Or worse yet ... lose on stupid investments you know nothing about!! To my wife Becky and myself ... all my latest equipment and office we built and the beautiful one we rented years ago is not overhead ... It it more important that what my salary from the practice is! ... Dentistry is who I am and what I am .. and comes before my take home salary! .. That is not overhead ... That is an investment in ourselves, our patients and our careers! .... And ... oddly enough ... If you stick to your principles ... you will still have plenty to waste in your personal life too ...
I wouldn't use Nitrous Oxide in my practice after the study came out that the secondary inhalation of it can cause DNA damage to the sperm causing infertility among other things. What else might it do or to the patient using it under the heavy therapeutic dose for 1 hr every 3, 4 or 6 months for a prophy?
Eventually become the kind of dentist that patients will SEEK OUT! Instead of the majority SEEKING patients their entire career...... does this make sense? Eventually Choose and treat only the best. Only the ones that care as much about their own teeth as you do! ... Conversely, get rid ot the patients that don't put any value in their teeth, don't maintain them at all, only come in when something hurts on an emergency basis and mess up your day and schedule. Putting themselves ahead of your regulars that do care about their teeth. I tell these patients to find another dentist that cares as little about their teeth as they do!
I personally make & place all of my temporaries, take all of my impressions, Cerec designs, place all my matrix bands, finish removing cement etc. I feel the patient is paying good money at our office for the best & deserves as much of my personal attention as possible.
For after hours (REAL) emergencies on established patients I seldom charge more than I would during regular office hours. If it is not an emergency .... Just a patient not willing to wait till Monday I will charge. Don't ever call in scripts to the pharmacy for new patients or other dentists patients if you are on call (or old patients you haven't seen in a while) without seeing them & having a signed health history. Anything goes wrong it's your ass! Send them to the emergency room at the hospital if it's that bad .... Or make them come down to office & fill a health history out if you must take new patients on emergency your first year or so. ..... And charge for an after hours office visit with all new patients. Also get a call back phone # - always call it back .... if no answer or it's a phone booth .... it's prolly a drugger .... be careful ... they prolly won't show at your office & if they do .... be even more alert. We never keep any pain meds in the office period! The word gets out!
Don't charge for temporary fillings during office hours.
We hate paying taxes as much as anyone! Using the cash for toilet paper is more useful than what our government does with it!! But! - a voice of experience. Don't deduct your vacations. let me explain. When you go on vacation = GO ON VACATION! = NOTHING TO DO WITH DENTISTRY!! Don't go to Morocco to go to a dental meeting & attend all the classes just so you can sign in = pay a big tuition = just to write it off! IT is a red flag! All 3 of our audits were initiated over deducted trips which were finally allowed but not worth the mess & the extra costs any audit brings. When you do go to a dental meeting go to the best meetings! Check out all the new equipment and only go to the classes that you will really get something out of! Some of my favorites are Dr. Sol "Bud" Silverman (UCSF) Dr. John Svirsky (VCU) & Dr. William Carpenter (UOP) ... All 3 are world leading Oral Pathologists! I also like Ray Bertolotti (Bondodontics) once every year for the latest. We also enjoy the annual Burke Dental Symposium in Montery at the Naval Postgraduate School now run by UOP. Our local dental society always has some great ones each year too.
And as far as a corporate car - unless you travel between multiple offices or to the hospital regularly it is easier to just take the perdiem allowance which is a lot now. And most important - get a good accountant, and a good tax attorney ... First you want a good accountant that is really experienced in audits - that can usually handle most of it without getting corporate attorneys involved except for the most technical parts as their time is charged out at much higher levels.
When you incorporate - incorporate as an "S" CORPORATION! NOT A C CORPORATION - Research this with your tax attorney! To give you an idea how important this is - If you ever start as a full C Corporation and one week later decide to change to an "S" corp. the IRS will make you wait for a period of 10 years before you can switch to an S Corp and take the "S" Corp tax benefits!!!! At any time you can change instantly to a full C corp from an S corp (if you are so stupid!). In an "S" Corp - you pay no corp income tax! You pay on your corp profits at your personal tax rate. In a full regular corp you pay your 17 % on all corp profits, and your full personal tax again on what's left as a dividend from your corp! If you are audited & ANY CORP DEDUCTION YOU TOOK IS DISALLOWED, THAT AMOUNT GOES BACK INTO THE CORP, YOU PAY FULL PERSONAL TAX + PENALTY & INTEREST AS A DIVIDEND TO YOU, THE CORP PAYS ANOTHER 17% CORP TAX, + INTEREST AGAIN & PENALTY AGAIN! If you get hurt, etc. or want to ever sell your practice for any reason - you die - your wife etc. has to pay full corp tax FIRST on the sale price, then you pay again, full personal rate tax too! As an S corp you have all the necessary controls over your pension & profit sharing plans.
Fund your Pension and Profit Sharing plans to the max you first 2-3 years of your practice, borrow to do it if you must ... getting funds to grow tax free from the earliest years is what builds substantial funds 35 years later.
Building your own office now may not be as financially rewarding as it used to be ... The cost ratio and commercial value later is much less ... But .... If that is what you want to do and you can afford it .... Just do it! And conversely ... the deductible rent of that really nice office is now even more financially rewarding too.
Then after the first 5 years or so always set aside a fund to update your equipment & office at the end of each & every year. It's tax time = let Uncle Sam help you pay for 1/2 of it. If you don't do this you will fall so far behind you will never be able to ride the crest of the wave to stay up to date with equipment necessary to keep up with the technology available.
USE ONLY HIGH NOBLE METALS (When you do use metal for your crowns) = TASTE, ALLERGENS, IT'S THE BEST! The word Noble in metals means nonreactive! And high-noble means the highest nonreactive metal we can cement or bond into a patients mouth!! We have NEVER done a non-precious crown! This does not mean I
can walk on water, but Gold, Platinum, etc. seems to have almost no metal fatigue and just goes &
goes & goes! Kinda like the pink rabbit? Hee-hee. For removable partials we use Vitallium 2, highly non allergenic and very low metal fatigue and is often used in joint replacements.
Never embarrass a patient by making them ask for one of their old gold crowns!
It's theirs! They paid for it! It can be sterilized. If they refuse it, we throw it in the
hazardous waste. I tell them, "if you found a nugget that size panning down at the
river, you'd tell the whole town about it! Plus it makes great jewelry!"
Seldom use porcelain to gold porcelain occlusals on posterior teeth unless you already have plenty of room for it. They will most often cause extreme sensitivity for years, due to being so over cut to make room for gold + 2 1/2 mm of glass. ... unless of course you already have the room afforded by and existing old restoration or you are doing one of the new Cerec Vita Porcelain inlay/onlays that uses the failed amalgam space or fracture site anyway. Cerecs are the same hardness and wear as natural enamel! ... For Cerec porcelain see our Cerec page and our Dental Philosophy Page
Taking blood pressure on every
patient for the last 36 years during every exam is probably the single most
important thing we have done in our practice along with our cancer soft tissue screenings by the hygienists and myself. Taking the Blood pressure over the years establishes a base line
for everyone and you identify the risk patients. It also enables you to
save more lives than anything else you can do by getting them to a
physician!
We have a stamp on the front of the chart for soft tissue lesion (cancer) exams also. The hygienist &
myself both examine each patient. Make comments there and and or on the Health History too, date & initial at each prophy & exam.
As soon as you can afford it, get a Digital Radiography System!!!! The more I use the one I have , the more I like it!! Saves TONS OF TIME! It is also much less radiation to the patient! We use the Schick system and really like it.
When you become very confident in yourself & your work, you will be at your
best when both you & the patient are relaxed! You don't need stiff formality,
the pin striped suit & tie to impress a patient. BE YOURSELF! laugh, put them at ease!
If the pin stripe is you - that's fine, a formal person trying to be informal is a joke too. But acting
like there is a vulture perched on the light and the patient might not make it
through the next filling is rather depressing! "Disdain for others is bred by conceit!" another Doc Hemp Quote.
My motto has always been "Look for reasons not to drill rather than reasons to drill!" What God gave us is & always will be better than anything the most gifted of you can ever produce! And never use Mercury scare tactics to remove good functioning amalgams.
One fish dinner gives us more Mercury than a year of a mouth full of amalgam fillings!
So, Patient education & preventive visits & home care are what's most important! As I have already said, develop a practice of only these patients! You have a right to not treat anyone that is belligerent or non compliant, as long as you give them time to find a new dentist and take care of any existing emergency problems. I write them a note & tell them they need to find a dentist that thinks as little of their teeth as they do!!! And that's the truth! Thfffffpth!
Always stay gentle! Don't get calloused with time to to patients fears and sensitivities. We still warm the carpules, use topical, inject a few drops .... wait and come back. (Of course ... you could just do it the HMO WAY -- No shot at all ... Show them the BIGGEST NEEDLE you have - put on your meanest face - and after they pass out - do the work & also charge them for a general anesthetic!) Hee-hee .... Grin! .... Now you Budwieser Frogs aren't supposed to be reading this remember!?
Always remember your regular patients FIRST. The ones that told their friends about you! The ones that made your practice! Once you become busy and you put most of your emphasis on new patients with the big $ cases, you will need that full page ad in the phone book and the paper to fuel the fire.
If we try some new adhesion technique, etc. that may save the patient a more expensive crown, bridge or partial, etc. & it fails within several months, we usually credit the cost of that procedure toward that crown, implant or bridge, etc. There are never any guarantees in dentistry, but this is a good way to try the newest stuff that can save the patient money if it works, but not at their expense if it doesn't - we have done stuff like this for my whole career. Heck, if the procedure is supposed to be so great & it doesn't work the patient shouldn't get stuck paying for it just because the lecturer you went to was all wet! (think for your self!!) All lectures have gems in them ... but some lecturers dislike clinical dentistry & lecturing is very lucrative .. use what you can and can what you can't!
If you really want to stick to your principles you should NEVER START by signing a contract with ANY of the 500 different insurances your state has! Bail out of them as soon as you can. Don't let them dictate your level of care! You must treat the patient not their insurance plan!!!!! You must develop a quality reputation with only quality work! Besides BIGGER IS NOT BETTER!!! Believe me! I tried it with an associate years ago ... The huge overhead increase to fuel the high gross necessary & the hundred fold problems & pressures you must deal with for a slight increase in net IS NOT WORTH IT!! The $1000/month yellow page ads to suck in the shoppers & trench mouth crowd just to keep the big machine rolling is idiotic! Do it right - take all the time necessary to thoroughly explain & teach your patients! That time spent will come back a thousand fold over the years as the word of mouth goes out.
Also, develop a Columbo mind to use the new technologies available to you! CEREC, etc. reinvest your money back into your practice before you invest it elsewhere else trying to become rich so you can quit dentistry early .. it just doesn't make sense. ... To sacrifice so much to attain that DDS of M.D, and then proceed in your career in such a way that you learn to hate it! ...If early retirement and the fast buck is your attitude, you went into dentistry for the WRONG REASONS my friend!
When you are in the office and attending dental meetings, etc. be 100% dentistry .. don't ever be taking phone calls at work that aren't dental oriented! ... It's not fair to your patients and staff ... And when you are out of the office and not at meetings be 100% family oriented and non dentistry (unless you have a web site - after your kids are grown .. hee-hee!) Get involved in hobbies! Do things with your family! Forget about the office .... we all need time away from work!
Still going strong and enjoying myself immensely! Still learning and keeping up with all the latest dental technology and equipment ... Intra-oral cameras for 12yrs now, Schick digital xrays for 10 yrs, micro-air abrasion, implants, and the latest now .. Cerec CAD/CAM Dentistry
Very few of the the entertainment celebs, muscians, etc. will seldom pay their bills ... They feel an autographed photo or a couple free CD's is worth whatever you might be charging ... a warning to the wise ... get paid up front! ... They are used to getting free hotels, meals, etc. and feel anything they might give you is fair trade as an advertisement fee.
Stay with the same wife or husband if at all possible!!!!!!!!! .. hang in there .. get counseling .. what ever .. as you get thru the worst part you will find a beautiful, wide sunny highway waiting both of you on the other side of the storm. Work it out! This is my and Beck's 43rd year ... she has been a jewel to have put up with me all these years!
Today .... 4-18-06 ... I just removed the largest, ugliest overhang we have ever had on a (wedged and deeper than a bicuspid band could reach root surface) D.O. amalgam I did a couple months ago. I just found it on the patient's recent B.W. appointment. These things will happen and get by you occasionally. As long as you fix these things at no charge when they show up you are still doing the right thing and a good job .... Had this patient moved and transfered to a new dentist before his next regular xray appointment with us ... That new dentist would have probably thought all our work looked like this and told this patient how bad we were and how good he is. BE TOLERANT ... If these overhangs are left over time after one knows they are there ... that is poor dentistry.
We usually take a free radiograph immediately afterwards on very deep and questionable ones like this .. somehow this one got by us. We are all human and it is how we handle our mistakes that makes all the difference in the world. If this ever did happen and the new dentist contacted us with the radiograph we would be thrilled to reimburse the patient so he could do it over for us if the patient was unable to return for us to do it ourselves.... So ... If there is any problems like this ... have the patient call their previous dentists office and ask the office manager to have the dentist himself call them back and try to straighten any problem out that way first .... 2nd if that doesn't work have the patient contact that states dental societies Peer Review ... they always have at least 3 dentists to physically examine the patient and review the case and will mediate and recommend a solution ... 3rd .... If that doesn't work then contact the State Dental Board ... but they never do an exam ... and only one person will look at the records and make any decisions ... 4th after that if it is really a serious problem maybe then the patient might consider litigation.
One last thing ... our staff has been with us an average of 29 plus yrs now ..... I have never ever asked any of them to reinforce the esthetics, quality, or the need for my work ... If you are sincere, do your best, and put your patients first, they will do it on their own and then it really means something! .... Likewise ... Giving production bonuses is also rewarding for the wrong purposes! A practice built on coercion and dollar goals for the dollars sake, will be an unhappy and guilt ridden practice eventually ! Most quality long term patients will eventually see thru this and you will be one of the full page ad guys in the phone book to just bring a breathing body thru the door!
Thank you for letting an old battle scarred 36 yr veteran ramble on. I hope to be doing some sort of dentistry into my 80's if my health holds out.
I hope you dental students like the web site and didn't find it too boring! Good luck in your careers. The age of dentistry with implants, digital xrays, air abrasion, lasers and 3D Cad/Cam type technologies is making dentistry right now the most exciting time I have ever seen!!!!!!!!!!!!! You will love it!!!!!!!!! And thank you to those of you that are now practicing and told us that our out look has helped you in your career decisions and your principles. Anyway, ... we know you can love dentistry as much as Becky and I have & do!
