Organic Practice Growth in 2016

Like most of you I use this time of year to sit down and reflect on the year past and dream for the year coming.  But here’s the sad truth – very few of us achieve our practice growth goals each year.  Or even worse, we achieve our growth goals but the cost of the growth doesn’t allow there to be any improvement on the bottom line or a decrease in our bottom line.

I don’t necessarily have a magic bullet, but I can provide some insight from my own personal experience.

Some of us are lucky that we can achieve growth by simply increasing our fees.  Unfortunately, for most of us (me included) that simply isn’t a viable option when you are under the confines of being a participating provider in dental networks.

So that leaves us with the other end of the spectrum.  Increase revenue through increasing production.

The problem lies in how we go about achieving this production growth.  Most of us fundamentally believe that practice growth comes from seeing more patients.  To increase your revenue you have to do more on more patients.  I am ABSOLUTELY CONVINCED that this logic is terribly flawed and DEAD WRONG!

What I am telling you is that you can achieve a 10% practice growth in 2016 without adding any additional new patients to your practice.  Now please understand, I am not saying you don’t need new patients.  We will always continue to need new patients to replace the lost patients.  But what I am saying is that we can achieve this growth without an overall net increase in the number of active patients.

The problem is that most of us are not general dentists but only restorative dentists.

What do I mean by that?  Most of your production comes from restorative procedures – fillings and crowns.  These procedures have a limit on the level of productivity you can achieve.  They simply don’t pay well enough to achieve a high level of productivity.  Those restorative dentists who are high producers are doing so by seeing more patients by delegation and efficiency.  There is absolutely nothing wrong with this, but it is a quick route to being unsatisfied and burnout.

The more patients you treat and the more you delegate, the bigger your infrastructure needs to be.  This infrastructure is costly.  It increases overhead and requires you to have to work harder just to feed the machine.

So how can you increase revenue without seeing more patients.  How do you become a general dentists and not just a restorative dentist.  There are numerous ways, but let’s just focus on four specific things you can do.

1.  Dental Implants

Dental implants are one of the fastest growing segments in dentistry.  The average overall fee for a dental implant from start to finish is around $3500.  The average chair time (in most offices) involved is about two hours.  This gives you an average hourly production of $1750.

To give this perspective the average single crown is about 90 minutes of chair time and yields a fee of about $900 (network insurance fee with buildup).  This yields an hourly of $600 – nearly 1/3 of a dental implant case.

Where are the patients for dental implants.  Already in your practice.  In the USA we are placing approximately 61 implants per 10,000 patients.  If the average practice has a patient base of 2500 patients then there are 12 implant cases right there.

12 implant cases at $3500 each yields 42,000 annually.  Again, without seeing an additional new patient.

Looking for a great way to get started in implant dentistry?

Consider attending the Sirona 3D Summit.  I speak at these events and there is no better way to get started in implant dentistry than with 3D imaging.

Already have Sirona 3D CBCT?  Consider our Ultimate 3D Workshop.

2.  Orthodontics

Adult orthodontics is a great avenue for production increase.  Patients are looking for easy, quick, and aesthetic solutions.  There are several great solutions for adult orthodontics – Invisalign, 6 month smiles, PowerProx 6 month braces, and Inman Aligner.  We aren’t talking about comprehensive orthodontics, but aesthetic orthodontics limited to straightening the front teeth to improve a smile.

The average adult orthodontic case yields about $4000.  If you were to simply enroll 1 patient per month into this type of treatment you would add an additional $48,000 annually.  The average orthodontic case takes approximately 3 hours (usually a lot less) of chair time.  This yields an hourly of $1333.  Still well above the $600 for a single crown.

Looking for great orthodontic training for a general dentist?

Six Month Smiles

Powerprox 6 Month Braces

3.  Sleep Apnea

Another high growth area in the dental practice is oral appliance therapy for sleep apnea.  The average fee for a sleep apnea appliance is around $2000.  The average chair time is about 1.5 hours.  This gives you an average hourly production of $1500.  Again, well above that of a single crown.

Where are the sleep apnea patients.  These for certain are already in your practice.  It is estimated that 1 of 15 adults have sleep apnea.  Most offices are easily seeing that many adults each day.  So the statistics say there is 1 person per day already in your office.  That means there are around 200 potential appliances annually.  If you were to only have a 10% case acceptance you would do 20 appliances.  That would be an additional $40,000k annually.

Looking for great dental sleep apnea training?  Consider our Sleep Apnea workshop.

4.  Medical Billing

Medical billing in the dental office is another untapped area in most practices.  The level of potential here can vary greatly depending on the procedures you are doing and whether you own a 3D CBCT machine.

Most dentists don’t even realize that medical benefits can be utilized in the dental practice.  For example, your examinations have greater reimbursement through medical than through dental.  Additionally, there aren’t frequency limitations like there are with dental insurance.  If you really want to maximize your sleep apnea potential, then you really better learn to utilize medical insurance.  Your bone grafting procedures are often a payable procedure through medical insurance.  As are your 3D CBCT imaging scans.  If you are doing any periodontal surgery, wisdom tooth extractions, sinus augmentations, dental implants (although a more difficult procedure to get paid for), and/or dealing with trauma cases then you are missing out from medical insurance.

My conservative estimate is that the average practice without a CBCT can add around $2000 per month ($24000 annually) and with a CBCT around $5000 per month ($60000 annually) to their practice.

Looking for medical billing training?  Consider our Medical Billing for Dentists workshop.

Putting It All Together.

The real beauty of what I just showed you above is that not a single thing I mentioned involved marketing for new patients.  In fact, the numbers will show you that these patients already exist within your practice.  Furthermore, what you will find is that the potential is exponentially higher.  The first step is deciding you want to do something and then getting the education to make it happen.

So that quick math says that I have outlined how to add $154,000 to $190,000 to your practice without marketing or seeing an additional new patient.  The kicker to all this is these are procedures your patients will thank you for and refer other patients to your practice for.

It’s About More Than The Money

Part of me hesitates to talk about money.  But I want to be sure to point out this isn’t just about making money and/or doing inappropriate things.  This is really about helping people and creating professional satisfaction.

It wasn’t until I was truly successful in my practice that I was able to start giving back to my community.  For me the freedom of practice success has been the following:

1.  Charity dentistry for those less fortunate in my community.

2.  More time off to spend with the family.  I have 3 young kids (10, 8, 6) and it is crucially important to spend time with them.  And vacations are the best way to do that.

3.  Empower my team to grow and earn more.  When I do better they do better.  When I expand my skill set they expand theirs.  A rising tide lifts all ships.

4.  Love dentistry again.  The rigors of insurance was starting to take its toll on me.  Running around with roller skates, not spending time with patients, finishing the day tired, and etc.

5.  Grow my business.  Once I became busier with the above procedures I was able to turnover the simple restorative procedures to an associate partner dentist.  This allowed the office to be open more and gave me freedom to take the time off without the fear of closing the office.

6.  Professional satisfaction.  I can’t remember the last time a patient got up after and MOD filling and said thank you to me.  But i can tell you the last time a patient didn’t thank me for giving them a straighter smile, help them sleep better, or gave them more teeth to chew with.  It’s simply more satisfying.

HOW TO GET STARTED!

Now that I’ve got your juices flowing, how do you get started.  Well the easiest way is to take advanced training.  There are many resources.  Of course, I am biased towards our workshops at 3D Dentists.  Our guiding principle is practice education that can be implemented in an insurance environment.  Our courses are based on exactly on the real world – after all, I’m a full time practicing dentist.  If you’d like some more information or have questions please feel free to email me directly.

About the Author Tarun Agarwal

Dr. Tarun Agarwal represents the next generation of leadership for the dental profession. As a respected speaker, author and opinion leader, he is changing the way general dentists and their teams practice.

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  • Tarun,
    Great article about growth within the practice. I took the medical billing course at your office last year and look forward to being able to take one of your other courses . I have the Galelios Comfort Plus, Omnicam, and place most of my own Implants. Still working on getting to make my own surgical guides, but the main problem is my preferred implant system. The best I can do at this time is construct a guide for the initial 2 mm drill and the finish the rest unguided. This works well in dense bone because the drills are self guided after the intial pilot drill.
    I’m doing quit a bit of grafting and will be taking Arun Garg’s Maxi course this summer to to expand my grafting
    procedures . I was invited to fill an open spot at a cadaver course in two weeks and will be able to practice any implant or oral surgery procedure ww can get done in 8 hours.
    The next time I am able to come to your clinic for a course, I hope to bring at least some of my staff. I have only four, including my hygienist. I know the size of your facility may not allow it, but if you could do simultaneous (but seperate) classes for management and clinical staff, I think it would be beneficial in these advanced areas of implantology , grafting, sleep apnea, and medical billing.
    I try to be as active as I can with cerecdoctors.com ( starting 4th year as mentor), but I know there is much to be learned from other instructors such as you.
    Hope to see you sometime this year.

    Terry Box

  • That would be great . If there is anything I can do to help in planning or delivery, let me know.
    Terry

  • Tarun,
    In regard to my previous reply and offer to help, I do work cheap!

    • T-Bone says:

      terry, i greatly appreciate the help. when the time is right (when i get my things in order) i will be sure to reach out!

      and as an Indian i love those who work cheap!

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