Dental practices: Fix the summertime schedule blues

Summer can be a challenging time for dental practices. With children out of school, families traveling, doctors and team members taking time off, data analysis shows that summer months can sometimes have a negative impact on a practice’s overall growth and profitability. But, by focusing on the right key performance indicators, it is possible to turn summertime dental practice blues into a sunny, successful season. (Hint: It’s about scheduling to goal vs. scheduling to fill the schedule.)

Clinical hours are critical

One of the first areas of focus: Production Per Visit, or PPV.
If during non-summer months, your practice produces around $100,000 in revenue. In June, that amount drops to $50,000 in revenue, even though you only took one week off for a family vacation. What happened here? If you only had one week with no production, shouldn’t your June revenue have been $75,000? This is a common occurrence, and the cause is often related to how you manage clinical hours.

There are three types of “hours” a practice can track: Clock-in, clinical, and chairside hours.
* Clock-in hours refers to the total number of hours you or an employee is clocked in; let’s use 8 a.m. to 5 p.m. as a typical example.
* Clinical hours are those you are available to provide dentistry. You might be in the practice from 8 a.m to 5 p.m., but during that time you take an hour off for lunch. A block of time might be set aside for you to manage the business. In this example, your clinical hours would be seven, not nine.
* Chairside hours are those you are actually providing dental care – examining patients, “drilling and filling,” performing cosmetic dentistry. In other words, the hours you are actually getting paid.

Which of these three types of hours are most impactful on your practice’s PPV? Clinical hours, of course. They’re the best way for your practice to establish and schedule to goal.

Perhaps you’re thinking “I want to track all three types of hours,” and if so, have at it. Doing so will be a challenge and frankly, probably won’t offer a meaningful return on the effort you put in.

Tracking your clinical hours and trying to increase your PPV during those hours is a much better use of your valuable time.

Photo: http://www.pexels.com

Scheduling to Goal


Ready to set your goal? Take your current PPV and multiply that by your available clinical hours.

As an example:
If your current PPV is $650 and your total current clinical hours for the month are 100 (25 hours per week x 4 weeks = 100 hours), that equals an average of $65,000 you can personally produce per month.
For your total PPV, add production hours from your hygienist, as well as any other clinicians.

With this powerful data in hand, you’ve removed the guesswork and generated hard facts to use in making wise decisions.

Put another way, if you are working ten hours this week and want to be producing $1,000 per hour, those managing the schedule should be looking for ways to ensure you’ve got at least $10,000 in scheduled production for the week.

Not quite there? You only have two ways to increase production – increase the number of visits or increase the amount of production per visit. The scheduler should be looking for the best opportunities to schedule to goal, such as higher-value cases, cosmetic dentistry, and crowns.

Scheduling to goal vs. scheduling to fill the schedule is your best solution to the summertime blues.

To learn how to get the most out of your schedule, set up a no-cost practice analysis with Dental Intelligence today. We’d love to show you what’s working well in your practice and what needs some help. Visit dentalintel.com to learn more.

About the blogger

Scott Livingston is the Director of Communications for Dental Intelligence. His focus is on helping the company to tell the story of how actionable data can measurably improve patient care, team collaboration and dental practice profitability. 

Outside of work, Scott enjoys spending time with his family, hiking the many trails in Utah, and serving others in his church and local community.

DENTISTING DURING CORONAVIRUS Part 5: Interview with Dr. Jason Auerbach

In this new series, we’ll be asking questions and getting first-person perspectives on what it’s like so far to practice amid the pandemic. Every region, every practice, every practitioner has unique stores so we’re chronicling them here to give you an up-close and personal look at challenges, solutions and inspiring moments across the country.

Oral and Maxillofacial Surgeon Dr. Jason Auerbach, otherwise known as @BloodyToothGuy to his nearly 130,000 Instagram followers, built Riverside Oral Surgery from the ground up. Starting with one practice, Dr. Auerbach now has four practices across multiple New Jersey counties. After graduating with honors from New York University College of Dentistry and completing a residency at SUNY-Downstate Medical Center, Dr. Auerbach committed himself to providing, in his own words, “with uncompromised care in an unparalleled setting.” He is a regular on New Jersey magazine’s annual list of Top Dentists. Dr. Auerbach is also an Incisal Edge 40 Under 40 alum and his Englewood location was featured in the magazine.

Q: When did you reopen your practice?

A: We never truly closed our practice. We were seeing emergencies throughout.

Q: What has been the biggest challenge so far?

A: The biggest challenge was deciding to furlough as many team members as I had to. I started my practice from zero with only one office and now we have four offices, 42 employees and six surgeons. Having to decide to furlough or lay off some of these people who I consider my family was probably the most emotionally difficult part. From a financial perspective, trying to figure out the financial side of things like how to navigate the legislation and the PPP was also difficult. Fortunately, we were okay with our PPE thanks to Benco.

Q: How have the changes in PPE affected your ability to practice?

A: Not really. In oral and maxillofacial surgery, we have been used to practicing with a ton of PPE because of our hospital experience. From the beginning, the biggest difference was figuring out the flow and teaching our team how to manage with PPE. It’s a different experience for us than for a general dentist or hygienist who is not used to gowning up and surgically working in a sterile field.

Q: How has the experience been with patients? Has it been difficult to encourage patients to come into the office?

A: Our patients have been looking forward to coming back, they want to get going and they’re looking at how and when they can get in. We’ve been very, very fortunate. Granted, there’s concern, but we’ve done a good job in terms of our protocols, procedures and implementing new technology. We know the patient is in the safest environment possible and we’re optimizing that whole side of our practice.

Q: Have you encountered any challenges with staff members?

A: There are childcare issues, younger employees who have young children have had trouble in terms of managing who’s taking care of them. As far as certain employees and team members having anxiety or fear about coming back, my practice has been at the forefront of practices in the area. We’ve been hosting live webinars with all kinds of experts in the field. The issue with my employees has been assuring them they are working in a safe environment and we are doing everything we can for them.

Q: Will dentistry ever return to what it was like pre-COVID? Should it? Or are the new precautions justified even in a world with a vaccine?

A: I think this will raise awareness for a lot of dentists who were a bit less cautious. Most of the people who are dentists now have been practicing only since universal precautions were established. What HIV, AIDS, and Hepatitis C did for bloodborne pathogen awareness and how we approach universal precautions, is what COVID-19 will do for awareness of airborne pathogens. This will bring a new standard for patient care and become our norm. We will all be aware of airborne pathogens in a way that we otherwise were not as dentists. As the years go on, we’ll better understand COVID, the pathogenesis, and what this specific coronavirus does. I think we will be in a situation where we will be able to handle it in a much better way. As long as you are protected and your team is protected and you’re taking into account what’s best for patients, yourself, your team and society at large, we’ll be alright.

Q: Your Instagram account has an international following. What did you think as you were watching the pandemic unfold in real time on social media, and was there any communication and collaboration between you and your followers?

A: I come at this from two different angles. My practice is looked to as a leader for guidance from all of these dentists and we are very honored and appreciative for that. I was listening to oral surgeons in Asia and Eastern Europe daily. I was talking to oral surgeons in Italy who were two or three weeks ahead of the United States. I was getting an understanding of what they were experiencing and I was assuming that we were going to experience the same things. Having international relationships allowed me to get in front of it here. I was very, very fortunate to leverage those friendships that have been formed on social media to help Riverside Oral Surgery. It allowed us to be ahead of the curve and allowed us to be progressive. We had aerosol management systems well before anyone even thought about it. We had air purification systems in place in the offices before anybody thought of it. We had sneeze guards in front of our reception areas before anyone thought of it. We were ready for this because I was talking to people who were going through it before I was. We really harnessed the power of social media. I was thankfully able to do that and it was a tremendous leg up and tremendous advantage.

Who Has The Power, The Followers, The Capital and The Biggest Ideas? Dentistry’s 32 Most Influential, That’s Who.

Incisal Edge magazine’s fourth annual rundown of our profession’s heaviest hitters has never been more fraught, because the industry has never faced anything quite like this pandemic.

From legislators to legends, international dentists to industry icons, Incisal Edge‘s 32 Most Influential People in Dentistry highlights the players who are shaping the future of the profession and industry. Some are new and emerging breakouts. Others are accomplished figures whose names you already know and whose relevance endures. You can debate and disagree with our choices, but one thing is certain: you can’t ignore them.

There’s one heavy hitter for every adult tooth—and each one is perfectly positioned to drive change. What have they done to make the list, and what have they set their sights on for the future? Plus, who are the contenders who narrowly missed our rankings, and who isn’t on this year’s list who made the cut last year?

Browse the complete summer 2020 issue of Incisal Edge to find out.

Or, read the feature on IncisalEdgeMagazine.com.

Tomorrow Is The Deadline To Be Part of AADR’s MIND The Future Initiative

According to ADA statistics, over 70% of practicing dentists in the United States are white. Recognizing the importance of creating and educating a more diverse group of dentists, The American Association for Dental Research (AADR) has been awarded a grant by the National Institute of Dental and Craniofacial Research (NIDCR). 

The AADR Mentoring an Inclusive Network for a Diverse Workforce of the Future (AADR MIND the Future) program is seeking applicants from underrepresented racial and ethnic groups, individuals with disabilities, and individuals from disadvantaged backgrounds. The network of mentors will support a “diverse pool of early-career investigators, including individuals from diverse backgrounds, in developing independent research careers dedicated to improving dental, oral, and craniofacial health,” according to the AADR.

How you can make a difference in the industry

After the application process closes on July 8th, ten participants and mentees will be chosen to commit at least 12 months of “intensive hands-on work, combining in-person sessions, with adjunctive distance-learning components.” 

Although only required to participate for one year, mentees will be strongly encouraged to extend their commitment to AADR MIND the Future program. The program will help mentor the next group of talented dentists while emphasizing the importance of diversity in the dental industry. 

For more information and to apply now, click here

DENTISTING DURING CORONAVIRUS Part 4: Interview with Dr. Lee Sheldon

In this new series, we’ll be asking questions and getting first-person perspectives on what it’s like so far to practice amid the pandemic. Every region, every practice, every practitioner has unique stories so we’re chronicling them here to give you an up-close and personal look at challenges, solutions and inspiring moments across the country.

Periodontist Dr. Lee Sheldon has been practicing for over three decades, so he has seen a lot of changes. An author and former associate clinical professor, he received his DMD from Tufts University School of Dental Medicine, and his certificate in Periodontistry from the University of Connecticut School of Dental Medicine. His practice, Solid Bite, is located in Melbourne, Florida. His recent article on creating brand awareness for specialists uncovered some startling survey results and offered a plan for countering lack of awareness—timely help as dentistry reopens under complex circumstances. 

Q: When did you reopen your practice?

A: We found out on April 30th that we could reopen on May 4th, but we really didn’t reopen our practice on that date. During the previous few weeks, we started to look at PPE and how we could refigure our practice to make it satisfying to both our staff and patients. We bought some equipment and some PPE. By May 4th and May 5th, we were writing, drilling, and rehearsing our new protocols. I started by giving about a half-hour PowerPoint lecture as soon as we got there on May 4th to let the staff know what we’re doing to make it safe. On Monday and Tuesday, we did not see one patient; we just rehearsed and got comfortable with the protocols. On Wednesday, we saw about half the normal patient load, same on Thursday and Friday. Usually, when you’re putting in protocols in an office, you’re doing it one at a time. But here, we are putting in seven or eight new protocols all at once, so we had to go slowly to do that effectively. By the time we were done on Friday, everybody was really comfortable. On Monday, May 4th, we told patients we were open and the phone started ringing off the hook. From May 11th on, we’ve been going gangbusters—every single day, every single week with a ton of new patients. Even with a slow first week, we had a fabulous May.

Q: What has been the biggest challenge so far?

A: For us, the biggest challenge was deciding what equipment we needed in order to feel like we have everything we need to protect our patients and staff. We have a reception room that holds eight people, but to socially distance correctly, we can only have three people in the room at one time. So they wait in the car until we have the ability to allow three people in the reception room or until we’re ready for their appointment. There was a little bit of difficulty initially doing the histories and taking temperatures. It’s an additional step, but once you’re used to the step, that’s just the way it is.

Q: How have the changes in PPE affected your ability to practice?

A: In general, I think there’s a lot more sweating going on. Unfortunately, we couldn’t get any gowns that were light weight and we had to order food service gowns, which are much heavier. We’re able to get some lighter gowns now so we’re going to throw the heavier ones away and start over. It’s more difficult to breathe in face shields and people are sweating but not to the point where the staff is complaining. You look at it in two ways: mild discomfort versus safety. Even the CDC guidelines don’t say you have to change gowns between every patient, but we’re changing our gowns between every patient. The difficulty was mostly in the planning, but we took the necessary steps to make sure that was done correctly so we can practice the way we need to practice.

Q: How has the experience been with patients? Has it been difficult to encourage patients to come into the office?

A: Almost no difficulty. There were a few patients who told us they’re putting off their visits for a month or two. The steps we took allowed us to see our patients with the same frequency, even in hygiene. The hygienists told us they didn’t need any more time between patients than they were taking already.

Q: Have you encountered any challenges with staff members?

A: No, and I thought we would. Two staff members arrived for that initial lecture and were a little bit reluctant, but once they saw what we were doing and were comfortable, they had no reluctance at all. I think it made everybody feel better. 

Q: Will dentistry ever return to what it was like pre-Covid? Should it? Or are the new precautions justified even in a world with a vaccine?

A: First of all, I don’t think we’re ever going to have a vaccine. We’ve never been successful with a flu vaccine; this will not be any different. We already have a feeling that the virus is going to survive. The virus wants to survive, it’s not killing off as many people as it was before. If the virus is changing, I can’t imagine we’re going to have vaccines that kill every mutation. Do I think it was appropriate to take the mitigation steps? I think it was long overdue. The last time we changed our protocols in dentistry was in 1986 after AIDS. To wait 34 years to change protocols was too long. Unfortunately, there is no standard protocol. We’re doing things that other people aren’t doing and other people are doing things that we’re not doing. We don’t know what is ultimately going to be correct, but increasing the discipline to decrease the possibility of infection and viral contamination is a good thing. Does it cost a little bit more money? Yes. Are we charging our patients $12 for procedures that use aerosols? Yes. We have gotten no squawking from patients when I tell them it’s an additional $12 fee for the particular visit. I think whenever you can put in some disciplines, it makes it safer for the staff. It makes it safer for the patient. I think it was a good thing. I wish we didn’t have this excuse to do it but I’m happy we did.

dental team strategic planning for the future

What is your future? That’s up to you and your dental team.

With all that has occurred over the past few months, many of us are left wondering what the future holds.  One way to add a degree of certainty during uncertain times is to engage your brain, and your team members in a strategic planning process.  There may be more questions now than previously, but by definition the future is uncertain, and yet we must create plans if we want to accomplish our goals.

Not long ago I oversaw a strategic planning meeting for a large dental practice. Levin Group conducted this all-day meeting, which resulted in the identification of 11 key strategies that the practice would like to achieve within the next three years. It took an entire day to work through identifying the practice’s core values, mission, vision, and ultra-specific strategies to support all their efforts.

Strategic planning days are some of my most enjoyable workdays.

Watching a group of dentists and office managers identify what they want to accomplish for their future is exciting and invigorating. Strategic planning isn’t a group of people sitting in a conference room picking ideas out of the air. These meetings create the opportunity for people, often for the first time, to look ahead, make plans, and believe that they are achievable.

  1. Strategic planning is a thorough process that starts by identifying a practice’s core values.  These are the underlying principles of the practice that will never be violated and allow the practice to make great decisions.
  2. We then perform a SWOT analysis where every pertinent practice issue is identified by the team, written down, categorized by strengths, weaknesses, opportunities, and threats, and then put into priority order. The top three from each category (strength, weakness, opportunity, threat) become the driving force behind the ultimate strategies that are selected.
  3. Lastly, we create a series of statements on where the practice will be in 5 years.

Select realistic strategies

With all of that “pre-work” complete, we have an excellent picture of where we stand and where we want to go, and it’s time to start selecting specific strategies to get there. The good news is that the strategies become amazingly obvious based on the work the group is already done.
One quick word of caution:  At this stage in the exercise practices often become excited and there is a tendency to try to cram strategy deadline into the next 12 months, but this will not work. It’s unrealistic and simply can’t get done. Instead, we recommend that you stage the strategies out over the next five years, establish deadlines, and then assign responsible parties.

Keep the momentum going

We conclude these strategic planning sessions by reinforcing that the practice must have a strategic plan update meeting each month to maintain accountability and keep the momentum going. The worst thing to do is to go through this whole process, stick the strategic plan on a shelf, and never look at it again. You want it to be living plan and therefore will need to update it every month to determine if you’re on track and decide if changes must be made.

About the blogger

Roger P. Levin, DDS is the CEO and Founder of Levin Group, a leading practice management consulting firm that has worked with over 30,000 practices to increase production. A recognized expert on dental practice management and marketing, he has written 67 books and over 4,000 articles and regularly presents seminars in the U.S. and around the world.

To contact Dr. Levin or to join the 40,000 dental professionals who receive his Practice Production Tip of the Day, visit www.levingroup.com or email rlevin@levingroup.com

You Can’t Live Without Them, So What’s The Next Best Thing?

While there’s no way around using handpieces during this pandemic, some may be better than others in terms of potentially mitigating risk. If you haven’t taken a close look at handpieces in a while, here’s a refresher on what to look for.

There’s no such thing as a “miracle” handpiece that generates zero aerosols. However, there are many options in terms of choosing the next best thing, which are handpieces that meet your clinical needs while reducing aerosol generation and the possibility for cross contamination as much as practically possible. Let’s quickly review some features and performance characteristics that make the most sense in terms of we know about reducing the risk of Covid-19 transmission.

A One-Two Punch Against Aerosols and Cross Contamination

Even if you know what the terms ‘anti-suck back’ and ‘anti-retraction’ mean, you might not realize how important their implications are in our current environment.

The issue of suck back first came to dentistry’s attention back in the 1990s. It became clear that air-driven handpieces were capable of transferring microbes from one patient to the next. That’s because, when air flow is interrupted for braking bur rotation, negative pressure can be created that can “suck back” fluids and debris into the handpiece’s air lines. This problem has been addressed by incorporating anti-suck back systems into well-engineered handpieces by reputable manufacturers. 

Not all handpieces incorporate anti-suck back technology. In fact, if you count in all of the cheap, no-name handpieces being sold through auction sites and questionable vendors, probably most of the handpieces worldwide don’t have anti-suck back features. The problem, of course, is that aerosols, fluids and debris that are sucked deep into the handpiece are more difficult to reach and properly sanitize. If the handpiece isn’t properly sanitized, the next time it’s used you’re exposing the patient, yourself and team to potentially dangerous aerosol.

Another safeguard is the use of an anti-retraction valve in couplers and micromotors to prevent water from being drawn back into the dental unit’s hose and water block. Since the hose, water block and valves are not sterilized, contamination presents a huge problem—but only if it occurs in the first place. Anti-retraction technology prevents this from happening, but once again, the higher quality the product, the more effective it is likely to be. 

It is important to note that dental units are required to have anti-retraction features, commonly known as duckbill valves, one-way valves, backflow valves and other names. However, handpieces are not required to have these features. Despite that, the very best handpieces do have anti-retraction built into the handpiece or coupler. Why? It acts as a backup. If the valves built into dental units begin to fail before a malfunction is able to be identified, the valve in the handpiece or coupler acts as a backup parachute of sorts.

An Ideal Time To Think About How Performance Also Impacts Your Safety

Clearly, if your handpieces don’t incorporate anti-suck back and anti-retraction features, you’re increasing the risk of cross contamination. That being said, it’s being reported that infectious disease experts now believe the length of exposure to Covid-19 and the amount of exposure are key factors in disease transmission. The risk would therefore appear to increase the longer you’re actually using your handpiece.

A solution would therefore be to use the highest-performance handpieces (and burs) possible. Doing so means completing procedures in the least amount of time, with the least amount of effort, and with the best clinical result which lessens the possibility that retreatment is necessary. Investing in high-quality, high-performance handpieces generally ensures you’re getting the benefits of not only anti-suck back and anti-retraction features, but also the ability to do faster dentistry that reduces the amount of time you could be exposed to Covid-19. Since dentistry is more time-consuming today, completing procedures faster contributes to meeting production goals as well, which is a welcome side benefit.

The Case For Investing In Quality and Safety

Obviously, low-quality handpieces offer none of the safety and performance advantages we’ve described. They don’t safeguard patients and your team, they don’t allow you to complete procedures as efficiently as possible, and they also may harbor microbes deep inside the handpiece that cannot be effectively neutralized through sterilization. Pre-Covid, we’d simply remind you that they cost you more money in the long run than they save you upfront. Now, however, they add a potential danger factor that cannot be ignored. It’s more important than ever to buy known brands from reputable dealers. High-quality handpieces last longer, perform better, can be relied on for peace of mind and are backed by their manufacturers for longer.

What Else You Can Do

As far as we know, aerosols are our biggest threat right now when it comes to Covid-19, and handpieces play an unavoidable part in generating them. However, in addition to choosing handpieces that address Covid concerns, there are other ways you can potentially ramp up your safety, like:

• Screening patients and doing reduced-contact check ins with stress-avoiding technology like OperaDDS

• Having patients rinse with a hydrogen peroxide or povidone-iodine solution before procedures

• Using dental dams to reduce airborne particles

• Considering the use of chairside extraoral suction

• Implementing enhanced air quality technology

Bottom Line

Benco Dental only sells handpieces by brands we know and trust, from our own Sterling line to exceptional names like NSK, Dentsply, KaVo and more. Now is the time to consider replacing your handpieces if they don’t meet the standards for today’s crisis. Look for the features we described as you browse the latest models in this issue of Big Big Deals. If you have any questions, be sure and reach out to your Friendly Benco Rep for help and answers. At a time like this, when it seems like everything is a little more complicated, choosing handpieces doesn’t have to be.

DENTISTING DURING CORONAVIRUS Part 3: Interview with Dr. Betsy Carmack

In our third installment of this new series, we’ll be asking questions and getting first-person perspectives on what it’s like so far to practice amid the pandemic. Every region, every practice, every practitioner has unique stories so we’re chronicling them here to give you an up-close and personal look at challenges, solutions and inspiring moments across the country.

Dr. Betsy Carmack is one half of a husband-wife dental team along with Dr. Tyler Carmack. The dynamic duo from Bennington Dental Center (and three other office locations) in Vermont are also current members of Incisal Edge magazine’s 40 Under 40 spotlighting the best, most innovative, most interesting young dentists in America. She’s also a mother of three, champion bodybuilder, and former International Medical Missions Coordinator for Operation Smile.

Q: When did you reopen your practice?

A: Officially, we opened in June. We did see emergencies throughout the period, but we weren’t officially open until June 1.

Q: What has been the biggest challenge so far?

A: Educating ourselves on the new recommendations and protocols, figuring out how to implement them, and coming up with a new protocol manual was challenging for us. I wrote a whole new, 10-page manual that encompassed the new guidelines. Trying to ascertain and find supplies that were not counterfeit was extremely difficult. It took a lot of strategic networking to order things with the hope they would arrive on time. It almost felt like a game show. It took a lot of resources and reading and things are still changing. One week, a circumstance could be okay and then the next week things could change. It’s like ‘Survivor.’ Some situations would change and you have to adapt to the new situation.

Q: How have the changes in PPE affected your ability to practice?

A: It’s been a learning process and a learning curve with the new material. It’s like training for the army…you have to wear all the gear and the uniform and you start running the race. It’s very heavy and hard to breathe. You have a full headlamp, you have your loupes, you have your shield on top of that. We have air filtration units for each operatory as well so you’re shouting through the mask and the shield and the air filtration unit through the suction to the patients hoping they can hear you. We have started doing virtual consultations as an additive to patient communication. It’s more difficult now to have meaningful conversations when you can’t hear or understand or see the doctor. It can be challenging when you have all the PPE on to convey different options to patients.

Q: How has the experience been with patients? Has it been difficult to encourage patients to come into the office?

A: I have found that most patients are eager to come back to routine care. A lot of patients were hesitant to reach out earlier during Covid in fear that they were not in pain. It wasn’t a dental emergency, but it was still a bother to them. Things are going to ebb and flow, but the majority of patients are happy to be back. I don’t sense a huge fear factor. Being in rural Vermont, the caseload is extremely low, and the patient is very safe in terms of what we’ve put in place as protective for patients and staff.

Q: Have you encountered any challenges with staff members?

A: Honestly, I think there was an underlying anxiety everyone felt from what the news publicized. Going into any new challenge is going to be intimidating when you are not used to something, but our staff has really been fantastic. After the first week, they settled in very well. You get headaches, it’s hard to breathe, your personal comfort is not as high as it was prior to Covid but luckily, all of our staff really like what they do. They miss the patient and personal interaction and they’ve been excited to come back.

Q: Will dentistry ever return to what it was like pre-Covid? Should it? Or are the new precautions justified even in a world with a vaccine?

A: I don’t foresee this ending or the regulations changing in the near future. The standard of care in dentistry has always included advanced infection control regulations and if anything, COVID has given dentistry the opportunity to revisit those guidelines. We all joke “I feel safer at work than going to the grocery store” because we’re screening patients, we do temperature checks, we’re allowed to question them and we have full protective gear on. I think it might be the new normal. Dentists fall into this interesting category where we can’t make any other income. A lot of dentists have reached a certain point and they said, I’ve been building my practice my whole life and rather than lose my home and my whole life I would rather start working again. The risks for young dentists are much lower and we’re not going to lose our livelihoods over that.

Second Time Around For The Families First Act

Now that practices are getting back to work, the Families First Coronavirus Response Act is once again relevant and deserving of a reexamination to find out exactly what it means for your practice. Most dental practices were forced to shut down prior to the FFCRA going into effect, so many have not had to comply with this new rule until now. It’s likely some offices have employees who qualify for paid sick leave under the terms of this act, and Benco Dental’s financial planning partners at Cain Watters & Associates are here to help offer clarity and direction to owners who may find themselves impacted. Let’s start with a refresher.

What It Is, How It Works

Beginning in early March, the Department of Labor’s Wage and Hour Division enacted the new Families First Coronavirus Response Act (FFCRA). Effective through December 31, 2020, the legislation outlines new requirements for paid leave for both employers and employees.

The FFCRA details that employees are entitled to paid sick leave if experiencing issues related to Covid-19. An employee is eligible for up to two weeks (80 hours) of paid leave at the regular rate of pay or the applicable minimum wage (whichever is higher) when quarantining per order of government or health care provider or when seeking a medical diagnosis for Covid-19 symptoms.

If an employee is unable to work out of a need to care for an ill individual that has been quarantined or to care for a child (under 18 years old) whose school is closed or childcare provider is inaccessible due to Covid-19; the employee qualifies for paid sick leave at two-thirds the regular rate of pay. Employees experiencing extended issues related to childcare can receive an additional 10-week paid expanded family and medical leave at two-thirds pay or two-thirds the applicable minimum wage (whichever is higher). However, businesses smaller than 50 employees may be exempt from providing leave due to school closings or childcare if the leave would “jeopardize the viability of the business as a going concern.”

Employer Credit

Aside from paid sick leave, the FFCRA provides a refundable credit to employers who are required to pay out either qualifying sick pay or leave pay.  The credits taken on the federal quarterly payroll tax returns are dollar-for-dollar and correspond with the paid leave requirements.

Exemptions

In most situations, under the leave pay rules (FMLEA), a small business is exempt from certain paid sick leave and expanded family and medical leave requirements if the employer employs fewer than 50 employees. Practices under 50 employees should claim this exemption, as requiring to pay leave pay for 10 weeks would materially impact practice operations and financial health, according to Cain Watters. However, note that some practices under 50 employees would still not likely qualify for the exemption – and that’s when you especially need expert advice.

Webinar: PPPFA and PPCRA Strategies For Business Owners

If this sounds like it’s getting complicated fast, relax. Cain Watters has a free webinar that helps break down all of this to help you navigate the rules and maximize loan forgiveness, including:

• Changes with the Paycheck Protection Program Flexibility Act

• HR issues with doctor or employee Covid-19 diagnosis

• Application of the Family First Coronavirus Response Act with reopening

Watch it here, or visit Cain Watters & Associates for this and even more helpful resources.

DENTISTING DURING CORONAVIRUS Part 2: Interview with Dr. Dave Monokian

In our second installment of this new series, we’ll be asking questions and getting first-person perspectives on what it’s like so far to practice amid the pandemic. Every region, every practice, every practitioner has unique stories so we’re chronicling them here to give you an up-close and personal look at challenges, solutions and inspiring moments across the country.

Dr. Dave Monokian, or “Dr. Dave” to his patients, has been surrounded by dentistry his entire life. In 2005, he became a partner and cosmetic dentist at Monokian Family & Cosmetic Dentistry with locations in Marlton and Haddonfield, New Jersey. Dr. Monokian graduated from New York University College of Dentistry and now serves as the President of the Southern Dental Society of New Jersey.

Q: When did you reopen your practice?

A: We officially closed down Monday, March 16th and we opened Tuesday, June 2nd.

Q: What has been the biggest challenge so far?

A: Prior to closing, we had a full schedule between dentists and hygienists. We had to cancel those appointments for the three months we were closed. When we opened again, there were emergency patients who called and the people who had appointments cancelled from March that wanted to reschedule on top of people who had scheduled six months before June. There just aren’t enough hours in the day or days in the week to see every patient. Making sure we’re staying equipped and have all of the right equipment for all of our employees despite the nationwide PPE shortage has been a huge challenge. And just coordinating the schedule — we can’t see nearly as many patients as we used to because of social distancing, trying to stagger appointment times and extending time for appointments to sterilize and disinfect the rooms. I would say those were some of the more significant challenges

Q: How have the changes in PPE affected your ability to practice?

A: It’s something that’s taking some time to get used to because we have to wear extra things and we’re changing things out more regularly now. It just affects the total number of patients we can see per day. It’s affected the overall production, revenue and number of patients we can treat.

Q: How has the experience been with patients? Has it been difficult to encourage patients to come into the office?

A: Even before the pandemic, we took a lot of pride in our infection control which has earned us a lot of loyal patients over the years. When all of this happened, we started on the process early. The day after we closed, I was on the phone trying to order things to stay ahead of the game. People definitely had questions but when we were closed we stayed in constant communication with our patients, sending emails and different types of correspondences. This was great to let them know the things we were doing and implementing in the practice to prepare them prior to coming into the office. The environment is definitely different with taking temperatures, asking various screening questions, things like that. Most of our patients trust that we’re doing the right thing because they’ve been with us for so long.

Q: Have you encountered any challenges with staff members?

A: They’re very supportive of what we’re doing and trying to lend a helping hand when they can. They had their questions about how we would do things and sometimes it’s a bit of trial and error as to how things go but they’ve been great. Our staff has really stepped up to help get everything reorganized and implement all of the new infection control. Dividing the team up to tackle certain areas helped a lot. We have team members that have been with us for a long time and they take pride in being a part of something special.

Q: Will dentistry ever return to what it was like pre-COVID? Should it? Or are the new precautions justified even in a world with a vaccine?

A: It’s probably always going to be how it is now. I remember when my father first started practicing and the AIDS epidemic hit. Before that, dentists weren’t wearing gloves or masks or much of anything; there was a new normal then. The biggest thing will be when we can finally get full PPE back in place and can get fully stocked with at least a month’s supply. Right now, we’re wearing two masks. Eventually, we’ll probably just go to one N95 mask. Our office put certain things in place that we intend on keeping. It’s all justified because you never know what else is around the corner. I don’t think you can ever be too cautious. You can screen and take medical histories, but there’s still a lot of hidden stuff out there. Vaccines give you more peace of mind but vaccines aren’t the be-all and end-all either. It’s difficult because it’s a complete unknown, but we’re in an industry working very close to people’s mouths with a lot of aerosols being created and a lot of potential to transmit something. The more caution, the better.