Back before the Renaissance and before Gutenberg’s
press, just about everyone farmed. They did everything;
raising cattle, chickens, sheep, wheat, corn and potatoes.
They made butter and milk and every single farm was the
most inefficient operation on the planet. Then people
started getting educated, and when people started getting
smarter, they started specializing. So rather than focusing
on raising cattle and pigs and corn and all the rest of that
stuff, they’d modify their entire farm to produce only
wheat or whatever would best be produced on their patch
of land – and productivity would go through the roof!
Think about health care, now. Even as soon as 1900
you had one doctor doing everything. He delivered your
baby. He treated your cysts. He amputated your arm or
your leg if you got an infection. He treated your gout. He
did everything, and he sucked at all of it. Now look at
where we are. In 2000, health care was 14 percent of the
GDP, and about half of all practicing physicians are specialized.
There is somewhere around 40,000 health journals
published monthly around the planet, each one
dealing with some specific part of the body or dreadful
malady. If you have prostate cancer, you’re not going to
see a doctor who treats all different kinds of cancer like
breast, liver or pancreatic, you’re going to see a doctor
who specifically treats prostate cancer and who has seen
thousands of cases of prostate cancer. You’re a dentist.
You’re a physician of the mouth. You know that doc who
works next door to you who studied ears, noses and
throats doesn’t know a single thing about
the mouth.
With professions specializing as
much as they have – even in the last
decade – why are most of you working
with a run-of-the-mill Certified Public
Accountant (CPA) who literally only
has one dentist as a client: you! OK, I’ll
try to be fair here; it is likely that your
CPA works with one or two other
dentists, but you know what that
means? Your CPA still doesn’t
know a single thing about
dental practices. When
you’re looking for
advice on equipment,
purchasing, remodeling or expansion, you’re going
to get a crappy, uninformed answer.
In the last 10 years, we’ve seen an evolution in
accounting and there are now hundreds of CPAs who are
highly specialized and focused solely on the dental profession.
Those of you who are on the message boards of
Dentaltown.com are likely aware of the most famous
one – Tim Lott (tlott@dentalcpas.com). I’m really pleased
that Tim is going to be speaking at the 10th Annual
Townie Meeting, April 25-28, at The Cosmopolitan of
Las Vegas, Nevada. Tim is part of the Institute of Dental
CPAs (www.indcpa.org). This group has CPAs across the
country who only work for dental practices. You also have
another specialized group of dental CPAs called the
Academy of Dental CPAs (www.adcpa.org) – founded
October 17, 2001, in Scottsdale, Arizona – and they
cover just about every geographical area of the United
States. One of the larger CPA firms I’m aware of that
works solely in dentistry is Cain Watters & Associates,
PLLC, out of Dallas, Texas (www.cainwatters.com). For
the best interest of yourself and your practice, I suggest
you ditch your current know-nothing CPA and hook up
with one of these cats.
(As an aside: Maybe your first step should be to ask
your CPA how many dentists he/she works with. There’s
a small percentage of you already working with a dental
CPA, and for that you should be commended! But maybe
some of you are working with a CPA who has 50 other
dental practices as clients – and at least that guy might get
you in the ballpark. I’ll write this again: if you’re the CPA’s
only dentist, get out. Then again, if you’re the CPA’s only
dentist and only cousin, that’s a bigger problem and I
wish you the best of luck over the holidays.)
There are far too many variances between dental practices
for a non-dental CPA to be able to give you any reasonable
advice. When we look at overhead for dentists
there is a huge variance from practice to practice. A solid
comparison depends on whether you are in a small, rural
farming village of less than 5,000 people in the Midwest
or if you’re in a highly saturated urban area like San
Francisco or Manhattan. You really can’t compare overhead
in a rural area to an urban area. Same thing goes for
rent or mortgage. It is so common in rural America for
the rent or mortgage on your practice to be one to two percent of sales. It is very common for rent in Manhattan
and San Francisco to be seven to 12 percent of sales.
Dental CPAs know this. They track the variances and can
give you a solid apples-to-apples comparison of your practice
to others. And here you are using a CPA who only
works with one dentist. You are crazy (maybe not as crazy
as someone who isn’t working with a CPA at all, but
still… crazy, man).
When you ask dental CPAs, “Should I expand? Should
I remodel? Should I add an operatory?” they have spreadsheets
and oodles of information at their fingertips that
they can use to show you the return on investment, the difference
between the return on assets and the return on
equity, and how all of it would affect your tax schedules.
Let’s have another look at CAD/CAM. Every single
dentist has considered this technology, but what exactly
does it do. It lowers your lab bill at the outset, sure, but
when you first get it, you might be taking two hours to
mill a crown, eating into the time you could be spending
with another patient. But then you have to take into consideration,
if you keep working with CAD/CAM in your
practice, you’re going to get better at it, and what took
you two hours to accomplish might only take you one
hour in a couple years. By then you’ll be making bank,
drastically lowering your overhead and increasing your
net income. Your dental CPA can help you make decisions
that will positively impact your practice like that.
They have the data from all of their dental clients that can
aid you in making an informed decision. This is called
benchmarking.
Toyota, Honda, Ford, Nissan, Kia and General
Motors are all obsessed with what each other are doing.
They benchmark each other to death! Benchmarking is
done in pro sports and every other industry – even in dentistry.
You compete with the guy down the street for your
patients’ business. Don’t you want to know how you rate?
Don’t you want to know where you excel and where you
need to improve? Stop using a general CPA and get with
one who is specifically involved with dental practices.
Guys, I see the traffic on Dentaltown.com. I know
what you’re into. You really want to learn how to do fillings
and crowns and root canals and you’re completely
obsessed with the “make something” part of business. You
all know you have problems with the “sell something”
part and as for the “watch your numbers” part, you’re horrible
at it. Usually if I ask a dentist, “Who watches your
numbers?” I hear, “Oh, it’s my brother-in-law,” or, “It’s
my cousin. He gives me a good deal.” You get what you
pay for, gang. Since you’re bad at watching your numbers,
you need someone who’s going to hold your hand and
help you through it. You need to go to a dental CPA who
can sit you down and tell you how your practice rates
based on information he’s gleaned from working with
hundreds or thousands of other practices.
When you’re working with a dental CPA, they can tell
you exactly what you need to do to become more profitable
because they can compare your practice to all of the
practices with whom they work – successful and non-successful
alike. Your dental CPA can tell you if you’re spending
way too much on hygiene labor (or not enough), if
you’re too high on supplies, if you’re low on assistant
labor, if you should purchase CAD/CAM to lower your
burgeoning lab bill and how much cash you should be
socking away for your future in case you ever feel like it’s
time to retire.
It’s time to wake up, gang. We know how much we
like making dentistry; it’s what we spent eight years in
school for, it’s why we take CE courses to maintain our
licenses and improve how we practice, and it’s what gets
us out of bed every day. But we all know how much we
collectively suck at selling to our patients what we do
(that’s another column completely), and we’re fully aware
how much we abhor watching our numbers to ensure that
what we’re doing is keeping our practices thriving. So if
you’re not going to watch your numbers, get someone on
your team who will, and make damn sure he or she is as
in tune with dentistry as you hope.
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