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What Happens if You’re Not There? by Frederick E. Heppner

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Header: Pulpotomy Materials: An Update
by Frederick E. Heppner

As a small-business owner, a dentist has many responsibilities to keep the business running smoothly—employing staff, maintaining the office equipment, and marketing for patient flow, to name a few.

However, with all the careful planning and attention to detail, there is one aspect that the majority of dentists don't plan for: how to keep the business viable if the dentist is unable to practice.

Every year a fellow practitioner may unexpectedly lose the ability to practice due to an unexpected injury or illness. Weeks or months of lost practice time will affect patients, staff and cash flow. Moreover, disability insurance has a waiting period before benefits will be paid—typically three months.

In this article, I wish to share events that I have witnessed, including how they were handled, in hopes that others may benefit through proper planning and organization.

The bad news
Since 1983, when I first became involved in dentistry, I have worked in nine major metropolitan cities and served clients in countless others. During that time, numerous events occurred that were both sad and frustrating. Dental offices were left stranded without a practitioner for a variety of reasons, including: a dentist needing time off for recuperation after emergency surgery, dentists with broken arms or hands, and unexpected death.

In these cases, the dentist wasn't able to treat patients, the employees in place didn't know what to do, and the spouse often did not have the business acumen to carry forth the business operations, and therefore the business faltered.

In the event of death, a practice's productivity would plummet until a potential buyer arrived with an offer far less than the previously thriving business was worth. Sad, but true—the estate of the deceased dentist may be left with little, if any, proceeds from the sale of an asset.

Most dentists carry disability insurance, but again, the period of time until benefits begin may be far too long to wait for much-needed funds. This can destroy a fine dental practice.

How to prepare
Carrying office overhead insurance can help manage operating expenses when little income is generated. This policy protects the short-term financial needs of a practice with payments until the disabled dentist returns to work.

But even overhead insurance has limitations—will the proceeds from insurance enable the office to remain viable, keep the patient base intact, and continue to employ staff until the dentist is able to work again or the practice is sold? Most likely the answer is no.

Rather than risking harm to a most valuable asset, dentists may consider becoming involved with a group of conscientious dentists in their community who would help preserve a practice if something unexpected happened to one in the group. This can help protect a practice and ensure it remains viable and is based on a simple premise: that the dental community is a caring one, willing to volunteer services for fellow comrades.

The concept is straightforward: form groups of similar dentists who agree to volunteer coverage for each other in times of illness, short-term disability, trauma or death. This is not the same as an insurance policy—rather, it is assurance that a practice, the team of employees, and patients will continue to be served.

These “Inter-Practice Protection Groups,” or IPPGs, as they have been called, provide coverage for the practice during a dentist's absence to ensure that it does not lose production, the team continues to work, and patients continue to receive care.

Group members operate their own private practices while collectively volunteering their time to care for patients and keep the dentist's office functioning while the doctor rehabilitates, or until the practice is sold. Patient payments for treatment that the covering doctors provide are made to the practice being covered.

Here are some general guidelines for effective operation of IPPGs.
  • The groups comprise about 15-20 dentists.
  • The group elects a chairperson and vice-chairperson. These people administer group communications and annual meetings, and coordinate activation.
  • Coverage is provided due to unintentional mishaps, illness, disability or death. Normal maternity without complications, substance abuse and alcoholism may not qualify for coverage.
  • Coverage may begin right away, but begins no later than 15 days after the date of disability, and continues for a maximum of 12 weeks.
  • Members covering a practice are not responsible for managing, administering or directing the business of the disabled member's practice. A personal representative, family member or other representative of the practice is responsible.
  • Members are not obligated to cover more than their allotted number of days. After the 12-week period of coverage has expired, the membership may agree to provide further coverage.
  • Members should contact their malpractice insurance company and ask them specifically: “In the event of my untimely death, will my policy allow for patients to be treated in my office by my staff under the supervision of a dentist volunteering their time and still provide malpractice coverage?”
  • Each member must review her or his personal information to be sure that the power of attorney is delegated to a significant other so that payments for accounts payable and payroll may be made without delay.
  • If a member is contracted with an insurance company as a preferred provider, then the member must find out guidelines for each particular plan in the event another doctor, who may or may not be contracted with that insurance company in his or her own practice, treats patients during a covered period. This will ensure payments for treatment rendered to patients are made to the doctor's office receiving coverage.
  • Members of the group agree that if a patient of the doctor who is receiving coverage wishes to pursue care from the volunteering dentist, the volunteering dentist will decline to accept the patient in his or her practice until a waiting period has passed—say, 90-120 days.
  • Prior to covering at another practice, a schedule may be faxed so that the covering doctor may review the patient load and treatment mix. Although the practice in which coverage is being provided will have on hand supplies, gloves, medicines and drugs, and instruments, the covering doctor may consider bringing some of his or her own instruments.
How it works in the real world
On the evening of July 31st, 2003 around 7 p.m., I received a call from a periodontist who is a member of the Concerned Periodontists, an IPPG in Phoenix, Arizona. He informed me that a fellow periodontist had passed away suddenly and unexpectedly at the age of 41 at his home that morning.

By 7:30 a.m. the next day, the coverage group was activated, and within a few hours a schedule was created in which 18 periodontists had volunteered their time over the next 90 days to cover the practice.

I arrived at the deceased periodontist's practice at 10:30 a.m. and the team showed me an enormous amount of gratitude and appreciation. To know that the doctor had thought ahead and aligned himself with a conscientious group of practitioners was such a relief to his staff, and to know the practice would be covered in this difficult time lifted a huge weight of concern off their shoulders.

In the following weeks, patients were treated, the staff continued to work, and the business continued to operate while the surviving estate planned for the practice's sale.

No one really knows what tomorrow brings. We plan for our practices to grow, we plan to maintain a happy and productive team of employees, we plan for retirement, and we hope to have enough insurance coverage to provide financial help in catastrophic situations. Working with an IPPG is just one more way to be prepared and have a plan in place so that your practice will continue to be productive, even when you're not there. Author Bio Box

Josh Wren Frederick E. Heppner has been serving the dental industry since 1983. He has enhanced dental offices across the country as a management consultant, and with his experience and knowledge in practice transitions, has helped dentists sell and buy practices with “win-win” results. His business management firm, Proactive Practice Management, specializes in professional, objective practice guidance for dental professionals nationwide, and Arizona Transitions assists dentists in valuing, analyzing, buying and selling practices. Heppner can be reached via cell, (602) 320-8073, by fax at (480) 513-0472, or e-mail at FredHeppner@cox.net or FredH@ADSTransitions.com

The Importance of a Support Network
by Cory Glenn, DDS
The year 2015 was a great year for my practice. We set records in number of patients seen, new patients and collections.

I was teaching courses frequently so I thought it was normal that I was feeling run down and achy. Boy, was I wrong. The day after Christmas, I got a call from my doctor that changed everything—he told me I had leukemia.

As dentists, our most valuable asset is our practice. But, have you ever stopped to consider that your ability to practice can be changed in an instant? An unexpected illness, the death of a loved one, or a natural disaster can bring very serious consequences. It's important to try and be ready for these curveballs that life throws at us by having great insurance and savings in place, but there are many things you just cannot prepare for.

I'd like you to ask yourself some questions.

Can I really sustain a 3-6 month pause in income while the bills keep rolling in? (Many insurance policies have elimination periods that are at least that long.)

If there's no one working in my practice for an extended amount of time, will I still have any practice or staff to return to once I'm better?

Where will my patients go while I'm gone, and will they return once I'm back?

The answers to these questions all have one thing in common: you won't really know until you find yourself in that situation.

But with a good support network, you should be able to weather the storm. This is where it's extremely valuable to have a network of dentists who are willing to bear each other's burdens to help keep the ship afloat.

For me, that support came from four groups I am involved in: the Tennessee Dental Association (TDA), the Tennessee Academy of General Dentistry (TN AGD), my local 4th District Study Club, and the Dentaltown community.

When I found out I would be unable to work for six months, I was immediately flooded with calls and emails from colleagues asking how they could help. We had doctors offering to come work at the practice for free on their days off, offers to provide cleaning and cooking services for our home, and offers to take on all of our emergency patients. I even had several Townies offering to have their bone marrow tested in case I needed a transplant!

It was overwhelming to know that so many colleagues had my back. Their generosity has kept my practice thriving so that I don't have to worry about going bankrupt as I undergo cancer treatment.

I want to encourage anyone reading this to find out how you can be involved in supporting your colleagues when tragedy strikes. Tennessee's TDA Relief Fund provides financial support to dentists facing severe hardship. If you have such a fund in your state, I'd ask you to consider a generous contribution—you never know when you may be the one in need.

Also, be involved in your state and local organizations. These are the dentists who are close to you geographically and have the organizational powers to actually step in and work in your practice if needed.

Finally, don't be a porcupine dentist! You know the problem with a porcupine? It's hard to get close to. The same goes for a dentist who has neglected to build professional relationships with his or her colleagues. The greatest joys in my career have come from interacting with other dentists through meetings, online forums, teaching, mentoring, and being mentored. The relationships you build with these people are the same ones that will carry you through your time of need, so don't neglect them!

Develop your support network now, before you need it, and be proactive about supporting your colleagues in need. Cards, meals and well wishes are nice, but they won't keep that dentist's practice alive. What keeps a practice going is another dentist that is willing to stand in the gap and take emergency calls, check hygiene, and work in the practice. These are just a few of the ways that you can help.

And if you ever find yourself facing an unexpected hardship like cancer, have the humility to accept help from others. I am so grateful and humbled by my colleagues who have rallied to support me through this. Because of their help, I can focus on recovering my physical health, knowing that once I do, the practice recovery will be no problem.


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October 2025
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