High Tech, Low Overhead by Douglas Carlsen, DDS


Dr. Doug Carlsen interviews Dr. Hall* to learn the secrets of his high-tech practice that maintains near 50 percent overhead.
* Doctor’s name has been changed. Also, few details are given regarding Dr. Hall’s identity. He is a real practicing dentist, as verified by Dentaltown Magazine. He wishes to maintain a certain degree of anonimity.


Many dentists love tech “toys,” yet pay the price of high overhead, often well over 70 percent and occasionally over 90 percent. I’m pleased to interview Dr. Hall, 59, who practices in the suburbs of a Midwestern city. Hall has fully embraced high-tech throughout his career, following in the footsteps of his dad, a dentist “gadget freak” even back in the 1950s.

Hall has been able to incorporate many of the technologies we all wish to have while keeping his overhead in the low 50 percent range.

Carlsen: You talked of your dad’s tech influence on your practice. Please elaborate.

Hall: I was fortunate to practice with my father for more than 25 years, joining him in 1980. Being a depression baby, he imparted a very sound financial basis to our practice. He was a cash kind of guy, yet did borrow on occasion, feeling the best thing was to invest in our practice. We knew more about it than anyone and certainly more than we did in the stock market.

My father was always very interested in gadgets and technology. He was an early adopter of stereo gear, color TVs, cordless phones and video. When I joined the practice and suggested we get a PC and a dot matrix printer to print out insurance statements he was all-in. It was 1981- 82 when we got our first PC. We paid over $2,500 for a machine less powerful than an iPhone is today.

As much as I am interested in technology I am not naive enough to think that machines will solve all of our problems. If you don’t have the right people with the right skills, most of that equipment will end up sitting in a corner somewhere.

You still need a receptionist who has great people skills who can engage new and existing patients, a dental assistant who can make people feel at ease, and hygienists who can make patients want to come back. I have often heard that technology makes for a cold atmosphere. I see it differently. If you can avoid having your staff ’s time taken up with repetitive tasks, which computers handle so well, it gives them time to do the things you want them to do: engage your patients, ask them about their families, ask them about where they are going on vacation, etc. If you have to spend your time filling out forms, you miss the important stuff.

Carlsen: Let’s go through the list of tech devices you use in your practice and how they assist you.

Hall: Video Conferencing: I use GoToMeeting extensively with both patients and specialists. After my initial examination I always have the patient return for a consultation appointment. I decided to see if patients were interested in doing this remotely. GotoMeeting allows the patient to log in and we review their radiographs, photos and chart online. It saves the patient the time and cost to visit the office. This has been received extremely well. I’ve also found the patient seems to be more focused on what we have to say to each other, possibly because they are in a very comfortable environment. Also, if I have a complex case I can often meet with a specialist to hash things out. In a much shorter period of time we can review records simultaneously.

Digital Radiography: This is a no-brainer, being easier, quicker and more diagnostic than film. I don’t know a reason why anyone would still be using film.

Cone Beam: It is certainly expensive but it makes you such a better dentist through better diagnostics. You and the patient receive more information and it leads to better dentistry. It opens discussions and patients accept further treatment.

Shade Taker: We use Shade Wave. The virtual tryins save me a great deal of time and deliver a more predictable result.

Digital Impressions: With our 3M camera, crowns fit better and we can deliver in less time.

Digital Phone System: We are now trying out new IP phones and telephone service by a company called Broadview. The really cool thing about their product is their software integrates with my Dentrix software. When the phone rings a screen populates information about that patient in a very convenient format. We see existing appointments, balances and treatment needed. It puts a lot of information at the fingertips for whoever answers the phone.

Carlsen: Let’s go to your website. You’ve told me that one’s website is crucial to a practice’s success, while I’ve heard stories of untold time spent and wasted dollars. Please describe your way of building a website that brings success.

Hall: When I started developing our web site, I came across a statistic that said the page that was most referenced on dental sites was “Meet the Staff.” That told me that people have and will always be interested in relationships. My website made it easy for relationships to be made and to grow.

I see sites with a lot of verbiage and photos of before-and-after treatment. I don’t think people want to read or look at all of the technical stuff. People want to be able to interact with you and the staff as easily as possible. My site has a few large buttons that allow new and existing patients to have a portal to view what they wish to view: make appointments, update their information, pay their bill and ask a question. Construct your website to be as easy to interact with as possible. I have photos, videos and written descriptions, but they are not the focus of my website.

Dentrix allows us to make and use true online registration—not the kind of form that the patient has to print, fill out and return to our office. This saves time for all:

1. My office staff doesn’t have to manually enter all the information—it imports automatically. If your receptionist isn’t spending time entering information, she can talk to the new patient and start developing that important relationship.

2. I can review the patient information when I have the time, before they are in my office. I often will Google their employer and get up to speed on what their company does. It is very impressive to a patient when you understand their work—yet another way to develop a relationship. And relationships are what allow people to feel comfortable with you as their dentist.

Carlsen: How do you keep your overhead low, even with all the technology?

Hall: Net profit is a function of how much you produce minus how much you spend. I think much of an office’s production has to do with relationships. The stronger they are the more likely your patients will seek you out and accept treatment, thereby increasing production.

In addition, when you institute the right technologies, you will be able to employ more productive people who are consistent in their tasks, creating a consistent product that has less cost. Increased production (treatment) with a more consistent product (less cost) lowers overhead dramatically.

Here is an example for a single unit anterior crown. We used to take digital photos and send them to the lab. We would get the crown back, try it in and often have to send it back to the lab to adjust the shade. Now we use digital shade mapping software (Shade Wave). It allows a virtual try-in that greatly improves our success rate. We also use digital impressions (3M True Definition). Crowns consistently fit better, with far fewer remakes and shorter appointments. More accurate fits with fewer shade changes definitely improves the bottom line.

Carlsen: Return on investment seems so important today for high-tech equipment. What has been your return on investment with your technological devices and systems?

Hall: When I was thinking about buying a cone beam system, the sales people talked incessantly about return of investment in terms of how many scans I would need to take to cover my monthly loan amount.

What I found out was that the equipment made me a better dentist. I provided superior diagnosis and implementation, allowing me to expand the conversation I was having with my patients about their dental health and needs. I stopped thinking about how many scans I needed to take a month and did the more important thing of concentrating on what is the best for the patient.

Those expanded conversations have led to a lot more dental treatment and the revenue associated with it than scan fees alone would ever produce. Return on investment has not been an issue in my practice.

Carlsen: What is the main thing you’ve done right with technology?

Hall: Most dental offices are similar, with a single dentist, a couple of dental assistants, some front office people and a hygienist or two. Being interested in technology and then dropping it in the laps of your staff is not enough. Implementation has to come from the top down. You as the dentist have to be willing to spend the time to learn the products and stand behind your staff when they need help. If you throw it in their court and walk away, it will never work.

You also must invest in an IT service. I have my IT service on retainer and it is one of the best investments I have made.

Carlsen: What suggestions would you give for both a new grad and an older dentist near retirement?

Hall: Technology is and will continue to be a part of dentistry. Do your homework, subscribe to dental blogs and listen to what they are saying, good and bad. Develop relationships with dental manufacturers and be willing to help them improve their products. Don’t be too disappointed when some products don’t work. Trust me, all do not do what they claim. Even if you are near retirement, don’t be afraid to upgrade. When you wish to sell your practice it will be that much more attractive to a young dentist wanting to buy.

  Author's Bio
Dr. Douglas Carlsen has delivered academic-based financial education since retiring from private practice in 2004 at age 53. He has no connection with any company or individual and speaks his mind freely.

Carlsen is very interested in speaking to your study club! Contact at 760-535-1621 or drcarlsen@gmail.com.

Over 25 videos available: search Dr. Doug Carlsen YouTube. Additional Carlsen Dentaltown articles are at: www.dentaltown.com. Search "Carlsen." Carlsen website is at www.golichcarlsen.com.

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