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ProfiTable PracTicedenTAl ediTion fall 2012
a helPful resource for you and your PracTice
Good facTs Make bad law
esTaTe PlanninG checklisT
invesTor denTisTs™
sellinG invesTMenT real esTaTe
PaTience for PaTienTs
buyinG a second PracTice
PracTice exiT PlanninG
is biGGer always beTTer?
and Much More!
1 | ediTor’s PaGe dentists and botox, content and contributors James Ruddy
2 | real esTaTe
The when’s and why’s of selling investment real estate Todd C. slaTeR
3 | accounTinG
want to realize Top dollar for your Practice? andRea Chan
5 | bankinG
how to Make sure your second Practice is a success WiTh Beau olmsTead
7 | feaTure inTerview
dr. John wilson and dr. Jannah wilson father–daughter dynamic duo ediToR WiTh John and Jannah Wilson
9 | feaTure inTerview
feature interview with larissa voytek
11 | PracTice ManaGeMenT
don’t worry, be happy! aniTa Jupp
13 | insurance
estate Planning checklist for dentists use This to eliminate your Tax bill maRk halpeRn
15 | MarkeTinG
attracting new Patients effectively – with Patience. daniel pisek
17 | invesTor denTisTs
investor dentists™ and the corporate Model dR. dev mangaT
19 | leGal
Good facts Make bad law maRiana BRaCiC
21 | PracTice valuaTion
napkin valuations – saving a little could cost you a lot! maRnie silveR
23 | PracTice ManaGeMenT
is bigger always better? TimoThy a. BRoWn
25 | sellinG a business
victimized by the Proprietary deal John WaRRilloW
27 | locuM denTisTry
one year of locums with Two locum stories dR. Ron BRoWn
28 | PracTice ManaGeMenT
Maniacs and Morons dR. david RoBeRTson
ProfiTable PracTicefa l l 2 0 1 2
profitablepracticemagazine.com
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ediTorial
Botox and Dentists, Content and ContributorsThis edition of profitable practice welcomes karen henderson as a managing associate editor. karen brings a wealth of experience and will be an invaluable resource for our readers. her review of a recent article in maclean’s magazine will be of interest to our dental readers.
Should Dentists Get a Piece of the Botox Pie?article Review by karen henderson
macleans.ca recently published an article entitled And the dentist says: brush, floss and Botox (http://www2.macleans.ca/2012/09 /05/brush-floss-and-botox). The question: should dentists offer cosmetic Botox treat-ments? The client interviewed in the article said she loved the convenience…one-stop-shopping saves time and research since she already knew and trusted her dentist.
B.C. agrees; the article describes a medical specialty spa, which on top of general dentistry, offers skin care, laser hair removal and facial rejuvenation (including Botox and fillers). The Royal College of dental surgeons of ontario compiled a panel of five experts to review “what and who should be using Botulinum toxin—if at all. no decision yet.
one ontario dentist brings in a local physician to examine patients and provide Botox treatments.
and then there are the turf wars…should dentists be encroaching into the territory previously occupied by dermatologists and plastic surgeons?
There is no shortage of opinions on dentists and Botox. some believe it’s unethical, others feel it’s responsible for a dentist to refer a patient to someone who is trained.
ophthalmologist Jean Carruthers, the plastic surgeon who brought Botox into Canada and remains at the forefront of research and development says Botox is an art that requires talent and experience. “you’ve got to be able to read the face. it’s not enough to have a cookie cutter,” she says. “But if dentists are willing to learn to do it properly, then fair enough.” The pacific Training institute for Facial aesthetics in vancouver offers two-day intensive courses across north america to medical personnel who wish to learn the skill.
Finally, a survey undertaken by The Wealthy dentist (http://thewealthydentist.com/sur-veyresults/28_botox_results.htm) revealed: “57% felt dentists are licensed medical professionals, fully capable of safely offering such simple services. The other 43% think dentists ought to focus on healthy teeth and gums, not Botox or Restylane.”
The word is out; what will you say if one of your patients asks if you provide Botox treatments as an added value service?
………………….
in this issue, we highlight the careers of a father/daughter dynamic duo. Dr. Jannah Wilson is a resident at an ottawa hospital who has done extensive international aid medicine and credits her family for her early career success. her father, Dr. John Wilson, is a dentist whose journey into dentistry reveals much about himself and his family, especially his relationship with his daughter.
our second interview with Larissa Voytek, the program director of the dental hygiene program at the ontario dental education in-stitute, offers insight into training and prepar-ing for a successful career as a dental hygienist.
some authors who contributed to this edition are:
Andrea Chan outlines an action plan for exit-ing your practice and obtaining top value for it. Dan Pisek reveals why ‘patience’ is required to attract new ‘patients’. Mariana Bracic explains a legal conundrum in Good Facts Make Bad Law. Beau Olmstead and others counsel dentists wanting to buy a second practice. Mark Halpern provides an estate planning checklist for dentists to be used to eliminate their tax bills. Todd C. Slater explains the when’s and the why’s of selling investment real estate. Timothy A. Brown offers insight into a unique sector of dental practice sales.
as always we welcome your comments and suggestions for making our magazine better. Pr
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Roi Corporation Brokerage
Publisher Roi Corporation Brokerage is licensed under the Real estate and Business Brokers act, 2002 (ReBBa).
James Ruddy ediTor-in-chief
karen henderson ManaGinG associaTe ediTor
natalia decius Full Contact marketing
desiGn by fullconTacTMarkeTinG.ca
how To reach us
leTTers To The ediTor
1155 indian Road,
mississauga, on l5h 1R8
subscriber services
[email protected] 1-888-764-4145
PerMissions
profitable practice: dental edition is printed and distributed 4 times a year by Jamieson-Quinn holdings ltd. dba advertising in print and is published by Roi Corporation Brokerage. The contents of this publication are protected by copyright and may not be reproduced without the written permission of Roi Corporation Brokerage.
The information provided through this publication is for educational purposes only. The publisher, by and through Roi Corporation Brokerage, shall not be liable to any person or entity with respect to any loss or damage alleged to have been caused, directly or indirectly, by the use or misuse of information, facts, ideas, or for deficiencies, defects, errors, omissions or inaccuracies in the contents of these materials.
This publication complies with the Canadian advertising-editorial guidelines and is published by Roi Corporation Brokerage for educational, marketing and informa-tional purposes only. our contributors are seasoned professionals who have agreed to share their advice in profitable practice and some of them partially fund this publication designed to provide our readers with timely information about industry news, analysis and stories in support of the dental profes-sion across Canada.
profitablepracticemagazine.comJames ruddy James Ruddy is the Editor of Profitable Practice Magazine and can be reached at [email protected]
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real esTaTe
by Todd C. Slater
hello everyone. i hope that you had a wonderful summer and took some time off to really enjoy it. i have found after speaking with many of you that while you do enjoy vacations, unfortunately you simply do not get enough of them because of that four letter word…“work”.in the last few articles, i have focused on the many benefits of owning the location where you have your practice, as well as owning investment properties. But two questions result - When is it time to stop owning?
What is my exit strategy?naturally there are the double d’s of death and divorce. in many situations either one could force you to sell your prop-erty but without these influences, why and of course when, would you sell?
first, let’s address the question of “WHEN?”For many people, they want to time the market just right. Buy low and sell high. as ideal as it sounds, it rarely works out that way. The “Flip”, as this action is commonly referred to, will sometimes yield a profit, but not nearly as much as when you’ve held the property for a long period of time. The desire for a quick property turnover is the method of speculators.
as an investor, the “When”, in most cases, should be “neveR”. as you pay down the mortgage of your invest-ment property and the value goes up, you are increasing your equity. if you do decide to sell, you will incur capital gains tax that will significantly eat into your profits.
There is much more lucrative way of handling the property… Re-FinanCe. Re-financing involves taking out some of the equity (cash) from your investment property that, inci-dentally, is tax-free. your tenant will continue to pay off this new debt once again. many professional investors use this technique to provide them with their main source of income.
now “Why” would you sell? The common reason is money and the need for it. Fortunately in the previous paragraph, we discussed the best solution, re-financing. The re-finance solution can repeat itself every 5 to 10 years. Based on the mortgage pay down and the equity increase, you are in position to have access to new money every so many years.
For those of you who do own your practice location, when it comes time to sell, the buyer of your practice may purchase the location as well. This may be of some benefit to you, but then again, you may want to rent the location to your purchaser with an option to buy. This will allow you to have some ongoing passive income while avoiding the immediate capital gains tax on both your practice and building.
in the end, the when’s and why’s of selling are strictly up to you. Consider carefully the benefits of re-financing versus selling and paying capital gains. investment real estate has been and always will be a strong avenue for investors, but the smartest (and richest) investors buy and hold their properties long term, creating generational wealth.
in the next issue, i will show you the breakdown of numbers as they apply to owning versus renting.
Thank you for reading and i will talk to you soon!
Bottom Line: This article provides simple-to-follow advice for dentists who own their practice location as part of their overall investment strategy.
Todd c. slater
Todd C. Slater is the President of The Simple Investor Real Estate Group Inc. Todd has been one of Canada’s top realtors as well as host of Realty TV for 4 seasons. With his innovative approach to managed real estate investment properties, Todd educates and provides investors with solutions and opportunities for investment real estate. He can be reached at [email protected] or visit www.thesimpleinvestor.com
The When’s and Why’s of Selling Investment Real Estate
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it’s a sellers’ market for Canada’s dentists. Those who put their practices up for sale generally entertain multiple bids and realize a premium on the sale. But before you decide to capitalize on your years of hard work, you should know that careful timing and planning are needed in order to maximize financial returns. Following are three ways to put some teeth into your exit planning so you can realize top value for your practice.
1. Develop a transition plana transition plan is a documented action plan setting out the specific steps and tasks required to successfully exit your practice. a plan typically includes:
your financial and business goals
a valuation of your practice
The form of the transaction (e.g., sale of assets or shares, phased or total transition, etc.)
anticipated net sale proceeds
Tasks to properly structure the practice
Tasks to enhance the value of the practice
a timetable.
developing this plan helps you think about your goals and how to operate your business in order to achieve them. The success of your transition will be a direct result of the timing and execution of this plan. since two components - structuring the practice and building its value - may require a number of years to put into place, it’s essential to allow sufficient time to properly address them.
2. Structure the practice essentially, there are two options for selling a dental practice: a sale of assets or shares. While purchasers prefer to buy assets because there are tax advantages and fewer liability issues, most dentists prefer to sell shares. This option allows you to claim the lifetime capital gains exemption whereby you can shelter up to $750,000 of the gain from the sale. This exemption can also be multiplied when family members hold equity shares and participate in the growth of the practice. so, for example, if you own a practice in ontario and de- Pr
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by Andrea Chan
Want to Realize Top Dollar for Your Practice? Put Some Teeth into Exit Planning
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cide to sell the assets of your practice, which is valued at $1 mil-lion, this could result in potential taxes owing of about $322,000. however, if both you and your spouse are shareholders who qualify for the $750,000 capital gains exemption and you sell the shares of the practice, the entire sale could be tax-free.
in order for a sale to be eligible for the lifetime capital gains exemption, a number of conditions must be met, including the following.
professional corporation: only the sale of shares of a small business corporation qualifies for the exemption. Therefore you need to have a professional corporation (pC) in place or to set one up at least 24 months before the sale of the dental practice. This is essentially a small business corporation that is subject to additional regulations established by the provincial or territorial governing body of dentists. The pC must be properly established and then the assets of the practice must be transferred into it.
asset use: substantially all (the accepted standard is 90%) of a pC’s assets must be used in an active business at the time of sale. This may require moving non-active business assets out of your professional corporation.
share ownership: shares of the pC must be owned by you and any family members (spouse, parents, children) for a minimum of 24 months prior to a sale. if you wish to access the capital gains exemptions of other family members who are not currently shareholders, this would therefore require advance planning.
active business: also for a period of 24 months prior to a sale, at least 50% of a professional corporation’s assets must be used principally in an active business or to finance a connected active business. since it is a common practice to leave retained earnings in a corporation in order to defer taxes, it is important to address any accumulation of non-practice assets to ensure the capital gains exemption is available.
Cnil balance: The cumulative investment loss balance on your personal tax return is another factor that needs to be considered if you wish to access the capital gains exemption. This balance (the amount by which total investment expenses exceed total investment income for tax years after 1987) factors into the calculation of the amount of the capital gains exemption available on the sale of shares. This amount might need to be reduced so that it doesn’t restrict access to the exemption.
3. Increase the value of the practice When assessing a practice, the more value that prospective purchasers find, the higher the sale price is likely to be. Focusing on the following strategies can help to reduce liabili-ties, increase efficiency and enable you to realize higher returns.
lease: if premises are leased it will be important to acquire the consent of the landlord to assign the lease or to secure agreement for a new lease, extension or renewal in order to prevent any delay of a sale.
employees: Job descriptions, performance reviews, contracts and payments for employees and independent contractors should all be up-to-date to prevent problems for a potential purchaser.
liabilities: ensure that taxes, debts, loans, leases and other obligations are paid up to minimize potential liabilities.
Transition support: Consider ways to smooth the transition of the practice to a new owner and to retain the patient base – perhaps retaining certain key employees, or having associate or staff member assist in introducing patients to the new dentist.
Financial statements: Comprehensive, accurate, timely records should be available for review by a prospective buyer. These include the past three years of tax returns for the practice as well as profit and loss statement for the current year.
accounts receivable: no buyer wants to pay for delinquent accounts receivable; therefore, it is important to implement a strategy to collect any aging accounts receivable.
systems: if your current systems are impeding the efficiency and productivity of your practice, consider a hardware/software update to enhance scheduling, production, billing, collections or financial reporting.
Typically, you may involve a number of different advisors in planning for the sale of your practice, such as wealth management advisor, lawyer, insurance broker and practice broker. Be sure that an accountant experienced with professional practices is included as a key part of this team. This individual can help to ensure that your business structure, practice value enhancement strategy and your retirement, estate and tax planning are all properly aligned to achieve your goals.
Timing is also crucial. With the aging of the baby boom gen-eration, today’s sellers’ market for dental practices may rapidly evolve into a buyers’ market – so put your teeth into exit planning today and enjoy a taste of your future.
Bottom Line: This article offers a ‘how-to’ plan to increase the value of your practice and prepare your exit strategy when you decide to sell your practice.
Andrea chan , c A [email protected] | 416-596-1711
Andrea Chan , CA is a partner of MNP LLP (www.MNP.ca) who works with dentists and other professionals to enhance the profitability of their practices and to achieve personal financial wellbeing for themselves and their families. Working with the MNP ExitSMART team, Andrea also offers professionals a compre-hensive succession program that accounts for every aspect of the transition process.
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admit it. you’ve been thinking about it. how great it would be to open a second location. To expand your footprint – and your brand – to a new part of town. and, let’s face it, to boost revenues and accelerate personal wealth creation while you’re at it.you know other dentists who have done it and things seem to be working out for them. and your practice is already thriving. it only makes sense to open up a second location. Right? it’s not like you don’t know what it takes to build a successful practice. you’ve already done it! how hard could it be?
“That’s one of the more common misconceptions we hear from dentists,” says Beau olmstead, vice president, Commercial Financial services, Royal Bank of Canada. “They assume a second practice will simply be an extension of their existing one. in reality, it’s like starting an entirely separate business. it’s a distinct entity and needs to be thought of and operated accordingly.”
dr. kevin aminzadeh knows all about the challenges of estab-lishing and operating multiple dental practices. after operating his first practice, eagle Creek dental in Burnaby for 4 years, he took the plunge and opened a second location, solace dental Centre, across town. Thanks to a lot of thorough planning and hard work, both locations are bustling. But aminzadeh admits that right from the beginning, even though he knew he would be doing similar work in each location, he saw how important it would be to approach practice #2 as a separate business entity.
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And Then There Were Two…How to Make Sure Your Second Practice is a Success
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Perfecting your business systemsaminzadeh says his single most important piece of advice for other dentists is to get the business systems in their existing practices working at maximum efficiency before they pursue a second location. “i would say that until you have nearly perfected all of the various systems in your first office, for example, the way receivables are handled, how patients are going to be greeted, the manner in which treatment plans are going to be discussed with patients and so on, you probably should not be attempting to expand,” he says. “if you don’t ensure all these business systems are working efficiently, when you add a second location, your errors will be magnified. your inefficiencies will be multiplied. it can quickly become a very stressful, unrewarding exercise if you don’t have a solid understanding of the business.”
To emphasize the point, aminzadeh draws comparisons to the way some of the world’s largest and most successful franchises operate. “Before they became household names, companies like mcdonald’s and starbucks perfected the systems required to make and sell their products,” he says. “perfecting those processes allowed them to then duplicate that formula in multiple locations. if you have the perfect system, buying or building a second practice can be a rewarding thing to do and can help you build equity.”
The importance of a critical eyeas vital as they are, however, great systems can’t compensate for fundamental challenges such as a lack of patient demand. “When you’re looking at buying or setting up a second practice, you have to be very critical of every aspect,” says olmstead. “if you’re looking at a purchase, ask yourself why it’s for sale. in the case of a build, you need to determine why that market hasn’t been served thus far. market demand for dental care is not influenced by supply. Clients aren’t magically spawned simply because you’ve opened a clinic.”
once you’ve done your all-important market research, olmstead advises to shine the spotlight on yourself. “it’s also critical that you’re looking at a second practice not from an ego perspective, but from a business perspective,” he says. “in other words, how does this enable you as a business owner to utilize your surplus cash in the most efficient way? and at the same time, you should also be asking yourself if there are perhaps other types of investment options that might be more aligned (in terms of returns, timing, diversification, etc.) to your personal financial plan.”
Safeguarding quality and consistencyWhen you make the move from one to two locations, it’s inevitable that you’re going to be somewhat less involved in the running of the original practice. For that reason, you need to ensure the mechanisms are in place to maintain the quality and consistency of care that’s served you so well in the past. Can your current practice afford to be leaned on in the first year to 18 months? Can it afford to suffer from potential cannibalization in terms of money, quality of service and operational controls? how important is your personal admin-istrative involvement in the operation of the current practice?
if the answer is ‘really important’, that might represent a potential deficiency when you pursue your second practice.
“To a great extent, maintaining consistency and quality in two locations has a lot to do with the people you choose for the various positions. They need to be conscientious and empowered to do their jobs,” says aminzadeh. “after all, there’s only one of you and you can’t be in two places at the same time.”
among the other decisions you’ll have to make: Will you have an associate dentist backfill your absence? or leverage their services as the core to one practice or both, allowing you to focus on specific case work? don’t make the mistake of thinking associate support is a trivial matter - it introduces many important short- and long-term considerations.
Getting the right financial partner in your corneropening a second practice can also be a daunting under-taking from a financial perspective. as such, it makes good business sense to get a strong financial partner on your team – one who’s used to working with health care professionals and who has a deep understanding of the complexities and nuances of the dental industry. The right financial partner will be able to provide you with the information, tools and financial solutions you need to position yourself for success in this exciting and potentially lucrative new chapter of your career. and above all, working with a team of experts can help mitigate many of the risks and provide you with sound counsel as you expand your business and your personal wealth.
Bottom Line: This article offers a plan of action to those dentists who want to open a second practice.The information contained in this article is for informational purposes only and is not intended to provide specific leasing, financial, business, tax, legal, investment or other advice to you, and should not be acted or relied upon in that regard without seeking the advice of a professional. Your advisor can help to ensure that your own circumstances have been properly considered and any action is taken on the latest available information.
®/™ Registered trademarks of Royal Bank of Canada. RBC and Royal Bank are registered trademarks of Royal Bank of Canada.
Beau olmstead Vice President, commercial Financial services royal Bank of canada
Beau leads the Commercial Health Care segment at RBC Royal Bank®. The Commercial Health Care team includes commercial account managers who have extensive experience helping health care professionals at every stage of their career.
Please contact Beau at [email protected] or call him at 604-665-5157.
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Editor’s Note: From interviews with both Drs. John and Jannah Wilson, it is obvious that the old saying ‘the apple does not fall far from the tree’ continues to have credibility.
When listening to dr. John Wilson, you are startled by the humble and self-effacing nature of this popular vancouver island dentist. With his patients he uses a “you’re the doctor, i’m the technician” approach to his dental practice. he doesn’t consider himself ‘special’ or ‘above anyone else’; as a consequence, he has developed sincere compassion for his many loyal patients. he believes that this philosophy is sometimes lacking in a small number of the younger dentists of today who see their dental career more from an investment perspective.dr. Wilson’s advice to young dentists is “become the best dentist in the world” and all else will follow. he urges them to spend the time necessary to master their dental craft, take the courses to improve delivery and learn how to communicate effectively with staff and patients. he encourages dentists to practice in small town environments where he feels the rewards are greater, both profes-sionally and personally. however, he qualifies this belief in saying that the small town should be close enough to a ‘big city’ to allow for the benefits a large cosmopolitan centre can offer. Pr
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Dr. John Wilson and Dr. Jannah Wilson Father–Daughter Dynamic Duo
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John possesses a ‘green’ side that is prevalent in many west coast Canadians. he is currently planning to build a cob house to improve his lifestyle and lessen his impact on his natural surroundings. modern cob houses still use ancient building techniques and materials like bricks made of mud, sand and straw and harnessing natural energy sources such as passive solar heating. To these older wisdoms are added the latest in today’s technological thinking; the result is an environmentally friendly accommodation and living style. While these homes might not appeal to all, they are highly efficient, cost effective, sustainable and low maintenance ‘green’.
growing up in gananoque, ontario, the son of steel worker, he had two choices: work in the steel mill or go to university. he is thankful he was born and raised in Canada and praises his parents for a ‘normal’ upbringing that allowed him free-dom and choice. he has tried, with his wife sylvia, to provide a similar upbringing for his own children.
one of John’s children, Jannah, is a surgical resident entering her final year of residency. like her father, she works hard - very hard at her chosen profession. a typical week at the ottawa hospital involves a minimum of sixty hours and sometimes, the hours served are twice that amount. Jannah loves the pace of hospital life. she enjoys thinking on her feet, calling on her manual and mental skills to solve the never-ending problems of providing quality medical care for her patients.
prior to medical school, Jannah worked in methadone clinics on the east side of vancouver. she taught a youth at Risk programme for troubled teens. she considered and explored careers in both sociology and law enforcement. she thought about a career in physiotherapy and worked as a fitness trainer at a rehab hospital.
What drives this energetic young professional? she freely admits she is an adrenalin junky looking for a challenge and the high she gets from her work on a day-to-day basis. she learned perseverance (a word she uses often) from both her sister and her father. her sister overcame a hearing disor-der from birth through sheer determination and hard work. Jannah grew up looking up to and out for her older sister. her father asked his children to strive harder at whatever they did and he himself lived the credo he encouraged in his children.
The possibility of following in her father’s pathway as a dentist was never rejected. While her father never encouraged any one career, including dentistry, he did ask Jannah to think hard and long before becoming a doctor. The endless, demanding hours that a career in medicine entails were his central concern.
Ten years down the road, Jannah hopes to have worked as a locum in hospital settings in at least three provinces. educated in French immersion classes, she wants to perfect her fluency in French and become truly bi-lingual. she loves the natural setting and lifestyle of British Columbia and hopes to practice in the northern regions of that picturesque province. as a child growing up in Timmins, ontario, she acquired a soft spot for ontario, especially its cottage country. For now, Jannah looks forward to another year of perfecting her surgical skills and procedures. her perseverance and patience coupled with her desire to problem-solve and volunteer as an interna-tional aid worker keeps her humble and balanced.
dr. John Wilson credits his wife and family for his being grounded, open and caring. Jannah concurs with her father. The unconditional love provided by her mother, her interactions with her siblings and the respect for others that her parents instilled, usually derived from dinner table discussions, was crucial to her development. her sister’s early hearing struggles taught her about human vulnerability. she laughingly related that her ‘brat’ brother taught her that patience was indeed a virtue.
Both John and Jannah fondly recall family dinner chats, when everyone related the events of their day. it became a time of sharing feelings, debating ideas and reflecting on everyday issues both big and small.
John and Jannah understand the need for a personal life and vacation time. They are active and physically fit, enjoying skiing, sailing and hiking. Jannah loves sports, travel and is happy riding her motorcycle whenever possible. John, in his spare time, is content to be busy planning and building a cob house. Both live life to the fullest.
Bottom Line: This article relates the lifestyle and interests of two health care professionals who just happen to be father and daughter.
dr. John wilson Dr. John Wilson is a dentist who practices on Vancouver Island and devotes time to living ‘green’ in his cob house. He can be reached through the editor of this magazine.
dr. Jannah wilsonDr. Jannah Wilson is a surgical resident in an Ottawa hospital who does international aid work. She can be reached through the editor of this magazine.
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larissa voytek is and has been the program director of the dental hygiene program at the ontario dental education institute (odei) since september 2004. she has degrees in science and psychology as well as a dental hygiene diploma. her masters of science degree in education specialized in Instructional Design for Online Learning.she is a director-at-large on the Board of directors and hamilton and district ambassador with the ontario dental hygienists association. she is also a member of the education advisory Committee with the Canadian dental hygiene association and an item writer with the national dental hygiene Certification Board. larissa is an advocate for dental hygiene education and private Career Colleges in ontario. she has recently joined the Board of directors for the ontario association of Career Colleges.
larissa still actively works as a self-initiating dental hygienist in private practice. she is focused on quality education, compliance, effective communication and relationship building.
larissa sums up her focus as “… being committed to enriching and building the profession i am involved in, through offering life-long learning and creating oppor-tunities and motivating people to strengthen themselves and achieve their maximum potential.”
larissa answered the following questions:
1. What led you to your present status as a program director at ODEI?
When i graduated from dh, i knew that i wanted to do something different. i connected in circles that interested me. i was working in private practice when the owner decided to start a dental hygiene school and because he already knew my capabilities, i was offered the program director position. it was a huge project that completely consumed my life for three years but it has been worth every ounce of effort to see the graduates in their careers and to see the staff and faculty grow and develop over those years.
2. What qualities do you look for in your students that you hope to encourage and promote in them to enable them to be successful dental hygienists?
The core dh qualities are empathy, critical thinking abilities, passion and listening skills.
Beyond this, i love to see students who are aspiring leaders or those who have diverse backgrounds. i believe these individuals will be instrumental in the future of the industry. dh is branching out into so many differ-ent directions; we need leaders to forge these initiatives ahead as well as others with specialized skill sets in subjects like organizational behaviour, social sciences, business, marketing and politics. Pr
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Feature Interview with Larissa Voytek
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larissa VoytekLarissa Voytek, Program Director of the Dental Hygiene Program and Director of Continuing Education at the Ontario Dental Education Institute of Canada. She is an educator, change agent and leader in her profession. She can be contacted at [email protected] or 905-304-9986.
3. What are the major challenges dental hygienists face today?
dental hygienists continue to put forth a lot of effort in order to differentiate themselves as dental hygiene professionals. The public is often confused about who does what on the dental team and many don’t realize the extensive skill set that dental hygienists have and the level of responsibility they carry.
education is also a challenge. There are few degree options for dental hygienists in Canada and no masters/phd programs in dental hygiene in Canada. education brings respect and recognition and in some ways the lack of options for dental hygienists wanting to further their education in Canada is limiting the profession as a whole.
independent dh is also a challenge. although we can now do this, the public still needs to be educated about these options.
4. Since you graduated as a dental hygienist, how has the perception of dental hygienists changed with the public in general and other professionals in particular?
The public is becoming more aware that dental hygiene is its own profession that contributes immensely to oral health in the community.
other health professionals are also starting to realize the same thing and partnerships are opening up between dental hygienists and other health care professionals. For example, there has been some work done with medical radiation technologists and respiratory therapists.
5. Were you surprised by the recent Globe and Mail article that placed dental hygienists fourth in overall job satisfaction?
absolutely not! our graduate satisfaction surveys show over and over that our alumni are satisfied with their profession. it’s a unique profession that allows strong relationship building and lots of opportunity to work with clients to help them improve their own oral health.
6. What do you do to unwind and alleviate some of the pressures you experience in your job?
Funny you should ask this, as i’m a huge advocate of balance in life. This is one of the key things that i discuss with students, particularly students who have difficulties in the program. my passion is horseback riding which i find to be so therapeutic. and i find that if i don’t ride for a period of time, i become less and less productive on the job.
7. What advice do you have for prospective students contemplating attending your institute in the future?
make sure you have some support around you and that you can balance and organize your life. dental hygiene is an intense program at any school. i would also advise them to spend some time in their own dental office to make sure this is actually what they want to do. although it is a wonderful profession with a lot of give-back, you are in very close contact with people all day long and that just isn’t for everybody.
8. What are your final thoughts or advice to dental hygienists about their career path and the state of their profession?
although there is some discussion that the job market is tight right now, the provincial and national employment surveys show that the unemployment rates in the profession are less than the national unemployment rates. so, that means things aren’t that bad. dental hygienists who are job searching need to do things to make them stand out and to build their skill set in order to be more attractive to prospective employers. This is how it is in almost every other job market out there, but for decades dental hygienists were few and far between and didn’t have to ‘go the extra mile’ to get a job.
also, due to lengthening of curriculums, increased retire-ment and reduced enrollment in many programs, the job market will open up with many new opportunities in about 3-6 years. dental hygienists were ‘teeth cleaners’; they now graduate seeing themselves as oral health care providers - important influencers in the overall health of clients, change agents and educators. They are graduating with a more entre-preneurial spirit and business skill orientation. The profession is advocating for significant changes to the responsibilities of dental hygienists including the ability to provide local anesthetic and prescribe radiographs. Big changes have already happened with self-initiation being granted, and there are more big changes to come.
Bottom Line: This interview with a program director at ODEI provides insights and information for dental hygienists working in their field and those considering enrolling or already enrolled in dental hygiene programs.
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by Anita Jupp
This is not a dress rehearsal for life, this is it, why not enjoy going to work every day. even after working in dentistry for over 30 years, i still have a passion for dentistry, i believe dentistry offers opportunities for both dentists and their teams. however, is everybody happy? The reality is that in any business there are good days and frustrating times. stress is a concern in many practices for many reasons. do you often go home stressed and frustrated?do you not want to go to work in the morning?
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Consider the following:
Step 1. Identifyidentify the cause of frustration and stress for you. make a list, prioritize and monitor the results. The most important thing is to not try to make all the changes at once. often when people try to change too much, the process becomes overwhelming and very soon they give up and revert to their old ways.
Step 2. Changemake a commitment to make the changes. it is important not to throw your hands in the air and give up. When you give up, so does your team. if you and your team work together, change happens faster and positive results occur.
Step 3. Consistencyinconsistency is the major cause why dentists do not reach their new goals and make the necessary changes. When things are going well, often the dental team relaxes a little too much and soon the financial side of the practice dips. The result is everyone goes back into high gear and dental practice life becomes a roller coaster ride. To avoid this, plan weekly meetings to monitor your changes and goals so that everyone stays on course.
4. The right teamall successful businesses need employees who truly enjoy going to work, love what they do and are excellent at what they do. in my experience, 60-70% of dentists are not happy with some of their team members. how can you work with someone when you wonder why you are paying them?
There are realistic, effective solutions for your practice - all you need is the confidence to implement change. you decide, answer the question below in the privacy of your office/home to determine - do you need support and solutions to improve your practice for you and your team?
often dentists get information overload and do not know where to start. it does not have to be difficult - prioritize, communicate with your team and set goals that are attainable. Be honest about what your concerns are. do not bury your head in the sand - that is an escape, noT a solution.
QUESTIONS:1. are you proud of your team’s customer service?
2. do you know how many patients you lose a month and why?
3. are you pleased with your new patient numbers and new patient retention?
4. are you pleased with your associates’ commitment to your patients?
5. do you have a system that monitors/documents the follow-up of pre-determinations and alerts you of the treatments that are not completed?
6. does your team communicate with your patients in a positive and encouraging way?
7. do some team members over-lecture or ignore your patients?
8. are work contracts and up-to-date office policies in place?
9. are you concerned with overhead and other expenses?
10. Could you be more productive without working longer hours?
11. does your team follow up with treatments, recalls, overdue recalls, missed and no-show patients?
12. do you collect 99% of what you produce?
13. do you have systems to protect you from in office fraud?
14. does your team believe in your fees and the quality of dentistry provided?
15. is there in-office conflict between some team members?
16. is there a team member accountable for the schedule, collections, follow-up treatments and who deals with any insurance concerns?
17. do you enjoy working with your team?
18. are you comfortable with the number of hours you work?
19. do you have a long range business and exit plan?
20. are your team meetings positive, enthusiastic and productive?
Bottom Line: Dentists should determine whether or not they need help to maximize the profitability of their dental practices and lessen the amount of stress and frustration they and their dental teams face daily.
Anita Jupp
Anita Jupp is a professional speaker and transition specialist whose career has spanned over thirty years. Anita is respected internationally as a practice management expert. She can be reached at 905-339-7843 or www.roicorp.com.
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did you know?The majority of successful dentists we meet are totally surprised when they discover their ultimate tax liabilities.you and your spouse may have been fortunate enough to accumulate substan-tial savings in RRsps and rolled those RRsps into a RRiF. did you know that 46% of your hard-earned retirement savings will be taxed after you and your spouse are deceased? in other words, your estate will pay the government $460,000 per $1 million of retirement savings.have you accumulated assets in your professional corporation/holdco? did you know that 32% of those assets will be paid as taxes on the second death of you and your spouse? your estate will pay the government $320,000 on every $1 million of investment holdings.
if you have accumulated capital gains from your investments, real estate or practice, did you know that 23% of those gains will be paid as taxes on the second death of you and your spouse? your estate will pay the government more than $1 million on $5 million of investment growth.
To sum up, the bad news is that a ticking time bomb called taxes is looming in your future. The good news is that all of the taxes described above can be reduced to zero with proper planning that you can begin right now.
Getting organized This is usually the most difficult step in estate planning.
The following series of questions and considerations will help identify your unique estate planning needs. When completed, contact us for help or share the information with your trusted advisors.
Distribution of assets prepare a balance sheet that includes all your assets,
liabilities and insurance policies. This will provide a financial snapshot with the amount and type of assets that make up your estate.
get help from a qualified professional to determine the tax liability of your estate. This can be quite complicated, especially if you or immediate family members are u.s. citizens or if you hold assets outside of Canada.
determine your family’s income needs. Will your estate have enough income to meet your financial obligations and desires at death? Will your beneficia-ries have sufficient liquidity to service personal debt, provide an income for dependents and allow for necessary savings for education, retirement, etc.? do you want to provide benefits beyond the next generation?
Will there be adequate liquidity to pay the expected taxes and estate costs and still leave a legacy? What is the impact of passing on certain assets, such as a business or family cottage, to only some of your children? are there enough “other” assets to ensure your estate is distributed equally or fairly? Can your beneficiaries share certain assets? Would this maintain family harmony?
do you have the proper amount and types of insurance to meet your specific needs, including income replacement, estate preservation, estate equalization and leave a legacy? are you paying for your insurance personally or using lower taxed corporate or holdco dollars? did you know that you can sell your personal life insurance to your cor-poration and get tax-free cash out of your company?
how do you want to distribute your assets among family, friends and charitable organizations? do you own specific items like jewelry, art, antiques that you wish to gift to family, friends, or others?
have you considered making tax-efficient charitable donations upon your death? Consider charitable remainder trusts, private foundations, donor-advised funds or a charitable gift of securities.
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Estate Planning Checklist for DentistsUse this to eliminate your tax billby Mark Halpern
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do you want your executors, trustees or beneficiaries to get professional help from specific advisors or do they already have the necessary skill sets? does your estate plan provide executors and trustees with the necessary powers to implement your estate plan effectively and efficiently?
family considerations do you need to make special arrangements to protect the
inheritance of minor children until they attain responsible ages or reach certain pre-determined milestones, such as attaining a certain level of education? is it your desire to keep your spouse and children in the family home?
are special arrangements required for infirm beneficia-ries, including protecting their social assistance or other government support on a long-term or permanent basis? do you have any other dependents such as physically, mentally or financially dependent parents?
are you concerned about a future marital breakdown of your children or your surviving spouse? Could that impact your estate? should you protect beneficiaries with poor financial judgment or skills, or those who might otherwise have trouble managing money?
are arrangements necessary in a second marriage and/or blended family situation for support of your spouse, while ensuring your capital passes to your children from a first marriage?
Ownership, beneficiary designations and trusts how do you own your assets? did you know that if you
hold an asset joint tenants with right of survivorship (“JTWRos”) the survivor will inherit it, as opposed to it being distributed according to your will?
is the payment of probate fees a concern? have you inad-vertently changed the ownership of your assets such that your estate plan no longer works? is there an opportunity to save probate and other estate costs on certain assets that don’t require probate - private company shares for example? does your jurisdiction have rules over type of planning?
have the appropriate beneficiary designations been made for registered plans (RRsps, RRiFs, Rpps, dpsps, TFsas) and insurance policies?
do you have two wills in place to eliminate probate taxes? does your will make use of trusts to reduce taxes on income and provide greater control over your estate with protection from creditors, including situations such as a marital breakdown?
Business planning is a buy-sell agreement in place? are there any other
shareholder agreements that govern the effective and efficient wind-up or sale of your business? are they structured properly? is the proper amount and type of insurance in place to provide the business liquidity? What if a key person becomes incapacitated - do you have proper insurance to implement a contingency plan?
should consideration be given to an estate freeze to mini-mize your tax liability and allow future growth to accrue to your children or successors?
if your family carries on your business, will there be enough liquidity to see them through the transition period after your death?
foreign considerations are you or your spouse a dual citizen or do you own any
assets outside Canada? if yes, have you considered potential u.s. estate tax issues? are there any plans to move out of Canada in the future?
do you have sufficient liquid assets to cover foreign tax liabilities?
does your estate plan address the potential for double taxation?
do your executors/trustees/beneficiaries reside in Canada? do they plan to remain here? have you addressed all the legal and tax implications associated with foreign jurisdictions?
address each part of the planWhen it comes to preparing an effective estate plan, there are many issues and questions to consider. The whole is greater than the sum of the parts, and each part of your estate plan must be addressed to ensure that all compo-nents work effectively together to deliver the best results. get professional help from an experienced specialist like a Certified Financial planner or Trust and estate practitioner and get started now while the sun is still shining.
note: The tax rates used in this article are based on current ontario rates.
Bottom Line: This article contains a comprehensive look at all of the main questions and issues a dentist should consider in the preparation of an effective estate plan.
mark HalpernMark Halpern is a Certified Financial Planner (CFP) and Trust and Estate Practitioner (TEP). He is the founder and president of i l lnessPROTECTION.com and one of Canada’s top life insurance advisors.
For your free, no-obligation consultation contact Mark at 905-475-1313 or email [email protected]
Get your free Estate Planning Toolkit at my website. It is comprised of 3 parts:
1. Estate Planning Checklist – know in advance how to organize your estate efficiently and eliminate taxes
2. Estate Directory - what if something happens to you? Will your spouse and children find every important document easily? E.g. wills, bank accounts, life insurance, etc.
3. Executor Duties Checklist – does your executor know what do? Keep this document with your wills.
I encourage you to visit illnessPROTECTION.com and get started now.
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by Daniel Pisek
you probably know the numbers that make your practice tick. you are also aware of the value of a new patient in year one, year two and beyond. and knowledgeable of the revenue and profit-ability of each individual treatment or service being offered. however, perhaps you are not aware of the extent that practice marketing can be utilized to help realize these business goals.in many conversations with dentists and practice office managers, the discussion seems to revolve around the desire for immediate results, and not “ bigger picture” thinking. This marketing planning approach, or “visioning”, is something that a planned, professional marketing approach can provide.
Be Pro Proactive MarketingWhile your need for a new patient response is immediate, there might not be a need for a new dental office relationship in any local home on any given day. This is where a proactive and planned approach to marketing comes into play.
We had a client meeting recently where the dentist was very specific: he wanted a marketing campaign that would specifically deliver new dental implant cases to his office. he paid little mind
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Attracting New Patients Effectively – With Patience.
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to the fact that his competitive landscape was loaded with high-end practices all wanting these same cases. The discussion seemed to revolve around what the message for this specific campaign needed to be, and how it would be executed. however, the more difficult discussion was getting him to see the benefit of taking a big picture approach to realizing a bigger picture success.
This is called “brand building”. starbucks, mercedes, nike: these are all brands you are aware of, yet they continue to do “marketing” and get their message out there. While the need to purchase might not be there today, when the successful dentist is ready to shop and choose their next car, the right marketing message can place mercedes “top of mind” and immediately on the short list.
The key is to have the right message in your campaign - the right message is the right mix of design and copy. The design and copy needs to be all about the consumer. The overall message needs to be about them and not about you. The right message will connect with the target consumer and spark the desire to learn more about you.
The other important element to getting the right message out to your target audience is ensuring that you use the right media to deliver your message. is it direct mail, magazine, outdoor advertising, transit, on the wall in the restroom of your favorite restaurant? you have many options, and you need to select the right one - the one which will connect with your target with the most frequency and reach, and stick with it for a while.
a great example of a successful marketing tool is our community newsletter program, where the goal is to attract families to our clients’ family dental practices. in our follow-up with these newsletter clients, many of them say it took two or three editions, but now clients in the local community almost expect it on a quarterly basis.
Tune up your marketing “engine”proactive marketing is much like a professional series car race: the race is not won or lost on the first lap. The race starts, and the car is fundamentally sound. it has four tires, a sleek frame, an engine that runs, and a driver who knows how to get around the track in a hurry. The most successful race teams are the ones that have the right approach, are consistent with their approach, and also make the needed adjustments along the way. We need to consider the competitive world of dentistry as a car race. The race is fast and the competition is fierce - and marketing is the engine that fuels your racing car to fly. The better tuned your engine, the faster you will get around the first lap, and the more competitive you will be for the long run ahead.
your marketing “engine” has five main elements you need to manage and direct, while also ensuring they are integrated and mesh well together to achieve better overall performance. The five “gears” are as follows:
1. your brand / practice identity: don’t kid yourself - your practice name and your office logo are the first thing to project your image of a progressive-minded practice.
2. your internet presence: your advertising is what sparks interest or an idea to consider you. your website and social media presence is what reinforces your credibility and provides a first taste of office atmosphere and patient experience.
3. patient communication: ask yourself this question: “on a scale of one to ten, how aware are my patients of the scope of treatment and services available at my practice?”
4. external marketing: do the people living around your dental practice even know that you exist at all? let alone the great patient experience they can expect upon joining your practice?
5. your team: are you making the most of your team meetings? The better you communicate with your business goals and marketing approach, the better your group can support your efforts.
Just like you expect a professional accountant to help you manage the big picture of your practice finances, you should expect a professional marketing company to help you manage the big picture of where you are going with your practice. Regardless of the stage of your practice, developing a marketing plan and a brand vision are key to long-term growth. many practices can make the mistake of focusing too much on the details of a specific campaign or commu-nication piece, without taking into account the long-term brand and marketing plan. The key to success and growth? patience. Because the more committed you are to long-term marketing, the more opportunities you’ll get to be “top of mind” with potential patients. Choose patience – for more patients.
Bottom Line: This article advocates a long-term marketing strategy and promotes the message that… ‘patience’ is necessary to attract new ‘patients’.
daniel PisekDaniel Pisek is the president of Full Contact Marketing, which specializes in health practice marketing. He can be reached at 1-800-728-6651 ext.24 or [email protected].
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in 2007, i read with interest an article written by Timothy a. Brown (Roi Corporation Brokerage) regarding the i-dentist™*. it was cause for pause and thought. having worked with one of the largest uk corporate bodies (oasis dental Care) as Clinical lead/Clinical Cluster director, some interesting parallels have developed. at present, corporate dentistry has taken an increasing share of the dental market. The largest player, integrated dental holdings (idh) has been merging with another group adp dental Company (adp) acquired 500 practices, 2000 dentists and for a 12% share of the dental market.
it is very likely that uk associates looking for a job will now find themselves in a practice operated by a corporate entity. The dental market in the uk is now divided into four sectors:
large corporate chains
smaller corporates operating in one region
independently owned groups of practices
single site practices with either an individual dentist or partners. Pr
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Investor Dentists™ and the Corporate Modelby Dr. Dev Mangat
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Clearly then, in the uk and now the us, the i-dentist™ or corporate model works. in alberta, this movement is gaining momentum also and some of the motives/incentives might include the following:
1. although there are guidelines set by the alberta dental association in terms of fees, there is no fee scale per se. This contrasts sharply with the situation in some of the other provinces and in particular ontario/B.C. This presents the opportunity of being able to charge for services on a level commensurate with skill and experience, something that has proved very alluring for clinicians in other provinces looking for the opportunity to increase practice turnover.
2. a lot of the most recent dental graduates are not in a position to invest heavily in practice acquisition as soon as they qualify and furthermore a majority of these newer graduates will be females where the work-life balance is becoming more important. The opportunity for the i-dentist™ in this situation is to be able to recruit these motivated young dentists at competitive rates of remu-neration. The advantage for the new graduate is to have the opportunity to be mentored.
3. i-dentists™ are also able to utilize the experience of former principals who can help with the above in a “mentoring role” and maintain their practice credibility as “lead dentists”.
4. The more savvy i-dentists™ recognize that they are not charities and have implemented systems and processes that needed to be in place to deliver profit. indeed, most are reporting increased earnings and as the number of practice acquisition increases this becomes more streamlined, with greater capacity for audit and accountability.
5. suppliers offer bulk purchasing discounts to larger customers and some of the i-dentists™ are able to reduce practice expenses considerably by using their own dental labora-tories and dental supply chains. This also increases the net income by reducing supply costs.
6. The fear about losing patients/staff is unsubstantiated. Retention rates have been much higher than we first anticipated, which obviously reduces concerns over loss of income.
For the reasons discussed above the demands for i-dentist™ practices in alberta continues to rise, most current investors are actively seeking to add to their portfolios and a number of new candidates are entering the market.
although we predict that these numbers will continue to rise, there are some possible restrictions:
1. With the current lending restrictions, some of the less sophisticated i-dentist™ models might have problems raising the finance to fund their prospective practices.
2. absentee ownership can be challenging, hence the need for a good support system and management team. This is often lacking with some of the newer entrants.
3. practice purchase selection is critical. The best opportunities are often associated with good quality general dentistry practices where the fee income is not reliant on one main clinician. a productive, empowered hygiene team is also a key to success.
given the risk and debt averse demographic of the typical “alberta dentist”, the biggest challenge for these would-be i-dentists™ is taking on the debt load and coming to terms with the notion of speculating to accumulate. interestingly, many of the same group of individuals have made forays into real estate and stock market investments where the risk profiles for these investments is considerably higher as has most recently been witnessed with the demise of the same. in comparison, dentistry is a business dentists know about. With a well-executed business plan, sufficient due diligence and a good quality appraisal, the risk factor diminishes con-siderably and the return on investment increases considerably.
For these reasons, any prospective i-dentist™ needs guidance from an experienced team that appreciates all the nuances. it is wise to seek professional advice from an industry leader.
* i-dentist™ is a trademark of Roi Corporation Brokerage.
Bottom Line: This articles tracks the growth of the corporate model of dental care, especially in Alberta, and outlines the major issues that an i-Dentist™ should know.
dr. dev mangat Dr. Dev Mangat was appointed in 2006 as clinical lead and clinical cluster director for Oasis Dental Care, a Corporate Body in England. In 2009, he moved to Canada and is now an associate for ROI Corporation Brokerage situ-ated in Calgary. He regularly attends courses worldwide and has a particular interest in esthetic and restorative dentistry. He can be reached at 403-607-1314 or at [email protected].
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by Mariana Bracic
a popular aphorism that first-year law school students love to bandy about is “good facts make bad law”. in other words, unusually compelling cases bring about a legal result that does not necessarily make sense in the realm of statistically normal situations. The tragic circumstances that led to the (arguably excessive) requirement that every small business in almost every province have an anti-violence program in place (including an on-site risk assessment, a customized policy— a template is not sufficient—and training of all staff) is arguably a case in point.
The Compelling factsin 2004, dr. marc daniel, an anaesthesiologist, met ms. lori dupont, a recovery room nurse, at the hospital at which they both worked: hôtel-dieu grace in Windsor, ontario. dr. daniel became obsessed with ms. dupont, pursuing her relentlessly, eventually persuading her to go out with him and finally pressing her into moving in together into her newly acquired house (much of which he paid for). Pr
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Before and during this time, dr. daniel had been disciplined by the hospital for having harassed three other nurses in the hospital (including breaking one nurse’s finger). The hospital launched an investigation into his workplace conduct. as a result of the investigation, dr. daniel was required to sign a memorandum of agreement requiring him to (1) go on probation; (2) abide by the rules of the hospital’s harassment policy; (3) obey the Code of Conduct; and (4) take anger management therapy.
on February 27, 2005, dr. daniel injected himself with anaesthetic. The hospital did not investigate this as the treating doctors in the acute psychiatric ward believed dr. daniel’s explanation that he was using drugs to deal with the pressures of work. They did not believe ms. dupont and her mother who argued that the suicidal attempt was a tactic designed to control ms.dupont’s behaviour. They told the treating physicians that they feared for the physical safety of ms. dupont and her child. ms. dupont broke up with dr. daniel while he was still in the psychiatric ward.
on march 10, dr. daniel was discharged from the hospital and began to stalk ms. dupont at the hospital and at home. her parents interceded to protect her at home. on april 5, dr. daniel placed nude photos of ms. dupont on her vehicle in the hospital parking lot. he also confronted ms. dupont’s father at his workplace and attempted to blackmail him.
Where was the hospital in all of this? you might reasonably be wondering. The hospital did make some effort to deal with dr. daniel after this incident. it cancelled dr. daniel’s security card access, asked him to get therapy and to pick up his mail elsewhere. it seems fair to say that as an employer the hospital failed miserably. however, as an employment lawyer who works on the employer side, i must say, in fairness to the hospital, given the way that the law stood at the time, they were likely advised and justifiably concerned about the enormous potential liability of wrongfully terminating or disciplining dr. daniel. The Courts have been clear that sexual harassment does not necessarily justify termination of the perpetrator and any experienced employment lawyer advising the hospital would have felt they were wading between scylla and Charybdis.
ms. dupont at this time sought a peace bond in the Courts. unfortunately, the final hearing was delayed tragically. in June, the hospital, reinstated dr. daniel without consulting the nurses, whom he resumed harassing. he kissed one nurse on the cheek and offered to rub another’s naked back. he intimidated ms. dupont by staring intensely at her and even body-checking her in the hallway. The nurses feared that he would “go postal”. The hospital viewed his conduct as a symptom of mental illness requiring treatment rather than discipline.
on november 12, ms. dupont and dr. daniel, almost incredibly, were scheduled to work together on a skeleton crew. When dr. daniel arrived, ms. dupont was already in the recovery room. dr. daniel stabbed her in the chest repeatedly. he left the hospital, called his wife to admit to the murder and to say goodbye. he then injected himself with a lethal dose of anaesthetic, dying three days later. ms. dupont died of blood loss that morning.
The “Bad law”?largely as a result of that tragedy, ontario, and now most of the other provinces have legislation intended to prevent violence in the workplace. While no one would suggest that the goal is not laudable, reasonable people may certainly differ over whether the legislation is appropriate or effective toward that end. in my view, it overreaches and is unneces-sarily burdensome to a small-business employer. it does not adequately recognize that what is required for an all-night business in vancouver’s downtown eastside is excessive for a bakery in guelph. While provincial governments would like to persuade businesses that compliance is easy and inexpensive, a review of the legislative requirements for compliance completely belies that. The overwhelming majority of our doctor clients across the country report that they do not feel they can become compliant on their own. and they are usually right: while it is not inexpensive to hire an expert firm, it is even more expensive for doctors to do it themselves (given the time required, the complexity, the steep learning curve, and the foregone billings that would be involved). in sum, it is an enormous regulatory burden for Canadian businesses, without a demonstrable reduction in violence or harassment.
on the other hand, my partner, dirk de lint, who heads up our firm’s anti-violence program for our clients, is of the view that the total beneficial effect on society is hard to assess this early, and may well exceed the burden on employers. in my partner’s opinion, while the regulatory burden is high, arguably, there is a salutary educational effect in society generally (because virtually everyone is an employee or an employer) that may prove, over time, to outweigh the cost.
While i would like to believe that he is right, i am not quite persuaded that the legislation could not have been drafted in a less burdensome way. however, the fines for non-compliance are extremely high (for example, up to $500,000 in ontario for a corporation).
The bottom line is whether you believe the legislation is well-drafted or not, if you are not already compliant, do ensure that you comply as soon as possible!
mariana Bracic BA(Hons) Jd | Founder, mBclegal.ca 905-825-2268 | [email protected]
Mariana is proud of the dramatic benefits of her completely unique, niche specialization (employment law + doctors) to her clients’ wealth and happiness.
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“i was hoping you could do me a favour. Could you eyeball a financial statement for me and let me know what you think a rough value would be?” here is a question i get asked fairly often, and my answer is usually. “sure i could, but is that really going to help you?” Taking a quick look at a financial statement, or using a “rule of thumb” to arrive at a business’ value can lead to a quick answer but often, the answer isn’t reliable or close to the company’s true value.
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Napkin Valuations – Saving A Little Could Cost You A Lot!by Marnie Silver
“Using a ‘rule of thumb’ to arrive at a business’ value can lead to a quick answer, but often, the answer isn’t reliable or close to the company’s true value.”
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Financial statements are always a good starting point, but they are only one source of information for determining a company’s value. There are often items buried or hidden on a financial statement that need to be adjusted. These items may not be noticeable until some probing is done and other documentation reviewed. For example, in owner-managed businesses there are often personal or discretionary expenses included on the income statement, items such as automobiles, travel, or entertainment. These items should be adjusted as they have a significant impact on the company’s real value.
a company’s income statement shows net income of $80,000, but after adjusting salaries to market rates of compensation, and reversing automobile expenses of shareholders’ relatives who do not work for the company, maintainable earnings are actually $200,000. Calculating the value based on each of the above income amounts yield very different results. if questions aren’t asked, and additional information reviewed, the quick answer will likely not be the right answer.
similarly, there may be assets that are not reflected on the balance sheet at all (patents or other intellectual property), or assets that are significantly lower than their fair market value (real estate). These assets may or may not be included on the balance sheet, but definitely add value to the company and need to be included in the company’s overall value.
Rules of thumb are usually based on some form of profit. Common definitions of profit include: eBiTda (earnings before interest, taxes, depreciation and amortization) or sellers discretionary earnings (earnings before interest and taxes but after a reasonable salary to owner). The problem is that rules of thumb ignore many other aspects that drive value.
For example, two different restaurants both have sales of $500,000, and reported income on their financial statement of $50,000. Both owners each work similar hours doing similar functions. The first restaurant pays rent of $3,000 per month, while the second pays rent of $15,000 per month. applying the rule of thumb to net earnings would yield the same value – but which business would you rather own? and which would you perceive as having a greater value?
There are many reasons and situations that make a proper business valuation a necessity. The most common reasons for a formal valuation include estate and tax planning, shareholder agreements or buyouts, divorce, divestiture and acquisition of a business to name a few.
Taking a short-cut often ends up costing more in the long run for a number of reasons –
The “quick & dirty” value determined is not representative of the company’s real value. decisions are made based on the wrong value and regretted later.
The CRa or the courts do not accept a value without proper supporting documentation. attempts to support the quick value after the fact cost more and cause unnecessary grief for all parties involved.
a number of years ago, i had a client who owned an auto mechanic shop. his accountant did a quick valuation on the back of a napkin so that he could complete a rollover and transfer the common shares to his son. The number on the napkin estimated the company’s value at $600,000. CRa came back and assessed a value of over $10 million saying the value was implied over 20 years of earnings in goodwill. a lot of time, energy, and money were spent fighting with CRa, and the client eventually settled on a value of $1.5 million. a matter only settled after considerable (unnecessary) profes-sional fees racked up, additional taxes and penalties were triggered, a lot of time was wasted and endless grief had by the client. experience has proven time and time again, that the “napkin shortcut” usually ends up costing much more in terms of time, money, and aggravation; however, i have no stories to tell about anyone regretting their investment in a proper business valuation.
For estate/tax planning, the formal valuation is like an insurance policy. spend the time to do it properly up front, and if CRa starts asking questions later, they are almost always answered by the valuation report that was completed.
Bottom Line: This article points out the importance of a proper business valuation report from the start to avoid problems down the road.
marnie silverMarnie Silver, CA.CBV, leads the valuation and litigation support practice group at SF Valuations, part of SF Partnership, a leading, mid-market, public accounting firm. SF Partnership provides a wide range of specialized services to professionals in practice. Direct line: 416-646-8085 E-mail: [email protected].
“If questions aren’t asked, and additional information reviewed, the quick answer will likely not be the right answer”.
“The “napkin shortcut” usually ends up costing much more in terms of time, money and aggravation.”
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by Timothy A. Brown
The north american dental industry continues to expand, due in large part to the increase in the average consumer’s dental iQ. various sources have predicted that total dental fees in Canada for the year 2010 will exceed $13 billion.With this trend towards ever-increasing billings, many solo dental practices are now grossing in excess of $1 million per year. What does this mean for the appraisal and the sale of such a practice?
a profile of the typical dentist, who is interested in buying a practice, reveals that they are:
Thirty to thirty-five years of age
have three to five years of experience in full time dental practice
are comfortable, at this early stage of their career, in producing thirty to fifty thousand per month in dental fees
on average, a full-time associate works twenty days per month and …
generates fees of $1,500 to $2,500 per day
earns 40% of fees, or $600 to $1,000/day
earns $100,000 to $200,000 per year, (part-time associates earn $50,000 to $100,000 per year)
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Is Bigger Always Better?Something to Consider When Selling a “Million Dollar” Dental Practice
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When asked to define their ideal practice, the buyer suggests that:
They desire to buy a practice with one or two full time hygienists
They want a practice with total gross income in the range of $750,000 to 1 million dollars
They are uncomfortable with practices that employ associates - they ponder “Why won’t the associate buy it – is there something wrong?”
They do not want the previous owner to remain in most instances
most do not desire to buy the real estate and the dental practice at this early stage of the financial plan
They do not want to be in any form of partnership or cost-sharing arrangement
a brief analysis of the past 100 appraisals i have prepared reveals that over 20% were of dental practices with gross incomes of $1 million or more. most of these practices employ associates, part time specialists or have partners.
unfortunately, i predict a continuing trend toward buyers offering lower and lower prices for these larger practices, when compared to the smaller, more manageable solo practice. in addition, i predict that the emerging trend for investor dentists™ (also known as ‘hands-off ’ or ‘absentee owners’) who are buying some of the larger practices, and then staffing them with past owners or new associates, will grow.
Today’s young buyers are very ambitious and confident. Financial institutions are more than willing to lend them 100% of the purchase price. While this bolsters buyer con-fidence, it does so only to a point. When the practice is too large, in terms of total income and the resulting investment required, the practice may become less saleable and the debt less manageable in the minds of today’s buyers.
The practice which has gross billings exceeding $1 million is a ‘status symbol’ for some, yet it may be difficult to sell in the current market. much like the most expensive and grandiose home in your neighbourhood - it’s admired by many, desired by few!
Bottom Line: This article identifies current market trends in sales of dental practices and the makeup of typical buyers and their motivations.
Timothy A. Brown Timothy A. Brown, President & CEO, of ROI Corporation Brokerage a company that specializes in dental practice appraisals, brokerage, consulting, locums placements, associate-ships and practice financing across Canada. Timothy can be reached at 905-278-4145 or [email protected].
Given the buyer’s criteria as set out above, who will buy these dental practices if they are put up for sale?
What price will these large, sophisticated practices sell for?
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The con man refers to his target as a “mark” – easy prey to be exploited.private equity (pe) guys are too polite to refer to their victims in such pejorative terms, but, as i learned this week from my friend dewey hammond, a partner at Chattanooga-based Four Bridges Capital advisors, pe firms now have a saying for a business owner who is an easy target: The proprietary deal.When acquirers use the term “proprietary deal” they are referring to buying a business directly from the owner without the hassles of a “greedy” investment banker driving up the price by soliciting – or threatening to solicit — competitive bids for your company.
Falling victim to the proprietary deal is easy. you get approached by a partner in a pe firm or a senior person from a big company in your industry you know and respect. They shower you with compliments about your business, invite you to a fancy lunch and then ask if you’d consider selling. once you agree to a conversation, they convince you there is no need to involve an advisor to represent you – why pay the money, they’ll say, to some guy or gal who has done nothing to help you build your business – we’re friends after all. Pr
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Victimized by the Proprietary Deal by John Warrillow
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But becoming the mark in a proprietary deal is much more expensive than having your wallet pick pocketed by a street crook. here are five reasons to avoid being the target of a proprietary deal:
You’ll get a lower priceobviously with nobody else bidding for your business – without even the threat of a competitive offer — the price an acquirer will pay is lower in a proprietary deal. nothing drives up the value of your company faster than the possibility of two or three acquirers fighting over it.
Due diligence becomes protractedonce you agree to negotiate with one buyer, they will force you to sign an “exclusivity agreement” which allows the buyer time to do their due diligence. When a buyer knows they have a proprietary deal, diligence often gets dragged out for months.
Shrinkagenot only will due diligence become excruciating for you, proprietary deals often get discounted with the buyer low-ering their offer price after you’ve agreed to a set of deal terms. The longer and more painful they make the due diligence, the weaker you become to defend against a last minute price drop.
Seller’s remorseThe last time i was in marrakesh i bought a rug. The street vendors must have seen me coming from a mile away with my camera slung over one shoulder, map in my hand and goofy nike sneakers on my feet. i was convinced i was going to show them who was boss. By the time our negotiation was finished, i had bargained the price of the rug down by 50%. i walked away proud of my negotiating savvy until, on the ferry back to spain, i learned one of my fellow travellers had got his rug for 80% off the asking price.
When you sell your business, you’ll ponder whether or not you got a fair price for your life’s work. That’s natural but if you fall victim to the proprietary deal, with no other buyers bidding for your company, you’ll go to your grave never knowing if you were taken.
Out of market termsFour Bridges Capital partner hammond explains some of the less obvious dangers of the proprietary deal. “another buyer tactic in a proprietary deal is to keep the price agreed to in the letter of intent the same but asking for “out of market terms” on other economic issues that have the net effect of lowering the sellers take from a deal”. hammond continues, “Buyers running a proprietary deal can ask for an abnormally large escrow (a whack of cash you need to give to a lawyer to hold for a year) or work-ing capital requirement (the amount you need to leave in your company when you hand over the keys). other areas where buyers can peck away at value include the structure of earn-outs, consulting or employment contracts, or risk issues like how indemnification works for various repre-sentations that the seller must warrant to the buyer.”
at first blush, negotiating on your own with one buyer can look simpler. life is short after all and you might argue it’s better to make a quick sale to a friendly buyer even if you leave a few bucks on the table. But the illusion of the easy deal can quickly turn into what amounts to a one-sided swindle.
Bottom Line: This article alerts business owners on how to avoid becoming a victim of a ‘proprietary deal’.
John warrillow John Warrillow is the founder of The Sellability Score. See his website at www.SellabilityScore.com.
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by Dr. Ron Brown
yes, i have been retired for one year (sold my practice June 2011), and have completed almost a year of locum work.as a result, i have been able to travel, spend time with my grandchildren and yet work at offices as i can schedule match with varying offices’ requests. i have helped: a principal dentist who travelled to australia; another who spent time snowboard-ing on a Friday/saturday with his children; a new mother work 2 days a week with her newborn occupying her other 5 days for 6 weeks; and finally, an estate until the practice was sold when the principal dentist died in a tragic car accident.
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One Year of Locums
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Why do locums?i am able to keep my mind and fingers in dentistry if you will – i can help others with time off and relieve them of their anxieties about loss of staff and/or patients when they travel.
What are the expectations?The offices i have worked in want their patients treated with care and follow treatment protocols that they have established, record treatment and treatment recommendations and most importantly want the dental team used as a resource.
as a locum, i expect co-operation, value placed on our collective time and efforts with fair remuneration and good communication amongst all the parties.
My objectives:as a locum, we are invited into a practice to help—do not impose your ideology—work with the team and their concepts. do not compromise—if i am not comfortable with a treatment idea – i let the team know and we can refer or alter the treatment plan with the patient’s input.
overall, my experience has been overwhelming support by the offices i have attended. The team wishes you to do well for their benefit and for their principal dentist who is not in attendance. staff have shared lunches with me, suggested restaurants, and bed and breakfast sites (when i have travelled more than an hour from home).
The locum lifestyle is varied, challenging and yes… very rewarding in many ways.
Two locum stories by Dr. Ron Brownan elderly lady (who did not speak english well) was sent on her own for the extraction of a tooth. The team and i, with sign language and broken english, managed to convey the need of some radiographs to check her teeth, bones, and for any sign of infection. We sent a letter to her family outlining her proposed treatment, a prescription for antibiotics and fees involved. after three visits (with a family member to interpret) we had a pleased patient, with some extractions yes, but some fillings placed, her perio under control and a partial denture. i’m not sure who was more shocked—her 53 year old son or myself—when she hugged me at the end of treatment.
an older dutch lady in london was quite emotional on her visit after hearing of the original dentist’s tragic accident. after lots of TlC, we had her anaesthetized for her restorations. We allowed time for her between fillings and she managed very well. To everyone’s surprise (she only came to the office with problems, despite the original dentist wishing to do annual examinations) she booked for further restorations. she arrived with home-made cookies for all and left with a full smile—she hugged the assistant but did not hug strange men so she passed on me!!!
Bottom Line: This article with two attached stories gives insight into being a locum dentist after retirement from your practice.
dr. ron Brown Dr. Ron Brown retired from his practice in May of 2011 and now works as a locum and finds this a very rewarding experience. He can be reached at 905-793-1472 or at [email protected].
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i just heard the best analogy for dental productivity that i have ever heard.as dentists, we all reach a comfort zone with our production which is the net total of the way our office does hundreds of little things. These include the front desk, how the phone is answered, what you and your staff say and do, the proce-dures you are able to do and on and on.and we all feel that what we are doing is right. We feel maxed out and could not possibly do more than we are doing now and maintain quality.
so the analogy is driving a car.
When we are driving and someone goes flying past us at a high rate of speed, we think that he/she is a maniac, out of control, shouldn’t be on the road, etc.
let’s say our production is $3000 per day. When we hear about someone producing $6000 a day we often have the same kind of feelings. he/she must be some kind of crazed maniac that is out of control and must be doing poor quality work or over-charging or is somehow taking advantage of his/her patients.
now, how about the guy or gal driving along at 40 in a 60 zone? you think he/she must be some kind of moron; what the heck is he/she doing??!!
so we judge other drivers according to the speed we like to go at and we judge other dentists in the same way.
When we produce $3000 a day, and hear of someone doing $1500 we wonder what is wrong with him/her because it is so obvious to you how to do $3000.
What we don’t realize is the guy or gal who is doing $1500 a day thinks you are a maniac, and the guy or gal doing $6000 wonders what the heck you are doing all day.
But the point is not what anyone thinks of anyone else.
after all, the person who passed you at high speed that you thought was a maniac, may be a professional race driver and may be safer at that speed than the rest of us are at the speed limit.
and in the same way it is possible to do excellent high quality dentistry at a high level of production. in fact, the true irony of those criticizing the quality of someone else’s dentistry because their production is high, must not realize the only way to really hit big numbers is to do less basic dentistry and more complex (and expen-sive) dentistry. so there is a very high likelihood the higher producer is doing more complex work.
most of us could learn to drive better if we took a driving course. These courses teach not only how to drive fast, but also how to drive more safely through greater awareness and control of your vehicle.
and yes, we could improve both our productivity and our quality with the right training as well. especially in the area of case presentation. anyone can be a high producer if they are booked to do 4 bridges every day.
so don’t focus on the maniacs or morons out there; focus on yourself. are you really operating at your max or do you have one or two higher gears that you haven’t hit yet?
vroom vroom.
Bottom Line: This article uses the analogy of driving a car to a dentist’s productivity. Pr
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Maniacs and Morons
dr. david robertsonDr. Dave Robertson is the sole owner of a large practice with 10 associates. He has written several practice management programs for dentists and dental office managers. His office has also developed office management software that totally automates payroll, scheduling and reporting. He bases all his consulting on what works in Canada to grow and manage a practice. He can be reached at www.DentalManagementSecrets.com or at 403-984-0115
by Dr. David Robertson
Across cAnAdA2013
www.crosscAnAdATour.com
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Profitable Practice is hosting a national speaking tour on financial fluency for your staff and transitional planning for you.
The race to the exit gates is about to begin,
put yourself in a position ahead of your competitors.
