How One Dentist Went From a Struggling New Practice to a Successful, Happy Life.

“I spent seven months as an associate/slave and decided that was not how I was going to have a career in dentistry,” said Dr. Craig Slack, a general dentist in Clintonville, Ohio.

A graduate of Ohio State College of Dentistry in 1987, Dr. Slack bought his practice soon after his tenure as an associate. Upon taking over the practice, he quickly realized that the procedures in place were of little to no help in causing his fledgling practice to succeed. He was producing only $9,000 a month – this created a rather tense situation for he and his wife and family. Although he was producing at a low level, he had little time to enjoy life because of his constant struggles with the practice.

He finally realized that he was never trained in any business/practice management skills and that he needed some help. He hired a consulting firm but, unfortunately, soon found out that it was not structured for new practices. Dr. Slack said, “They were good for tuning up a Ferrari but they didn’t provide the rubber band to keep the engine running.”

He did some more research and hired a new practice management consulting firm in 1990. Things then changed dramatically. “They helped me to develop programs to bring in new patients. They put in organization. Job descriptions for staff were implemented, and this truly helped the staff to mature in their roles,” said Dr. Slack.

Dr. Slack explained that the practice just snowballed to higher levels over the years. “When we came back from our training, we saw a big jump in new patients and production. We always had good collections, around 95%, but even that went up to 98% and that has been stable for nearly 20 years. I think we’ve only had two down years in that entire time. We’ve had very steady increases with no plateaus,” he said.

With the help and advice of his consultant, he put internal and external marketing plans in place to drive in new patients. New patients that came in through internal marketing for referrals were the strongest, however. “They just seemed to be a more professional crowd,” he said.

“The consulting was great. This firm really taught you how to become your own consultant. My consultant only came out to the practice once for staff refresher training. Everything seemed to stick,” he said.

Dr. Slack continued, “The biggest benefit I’ve gained from consulting is that I learned to run my own office and know the basics that have to be in place to succeed.”

He’s been married for 22 years to his college sweetheart and has three children ages 20, 15 and 4. One of the things that he loves about having a successful practice is that he is now able to be a contributor to his community as well as having the time to do the things in life that he truly enjoys. He works closely with the Kiwanis Club, is an avid backpacker and has recently developed a passion for video production work.

“I went from $9,000 a month to over $80,000 a month and attribute that to the consulting I had. In my opinion, dentists are very afraid to change anything and only use what they were taught in school to run their practices. The problem is, what they were taught in school is wrong. I recouped my initial investment in consulting within two and a half months, based upon the number of new patients I received during that time.”

Dr. Slack wants all other doctors to have the same success and be able to enjoy the type of life that he does. He highly recommends getting outside help, if needed, to be able to achieve that. Learn what you need to learn to be successful, is how he now operates. He feels everybody should do the same if they want to have a happy, enjoyable life.

Displaced Dentists, Hurricane Katrina and Reciprocity

By Barry Levy, DDS

When the dental profession retains provincial ideas about how the profession is to be run and fails to address problems that exist, the idea of reciprocity between states in America becomes an issue that may slowly gain traction, but hasn’t been addressed in a manner that deals with disasters that can affect those that practice.

While members ask for reciprocity, the profession has failed to address several quality of care issues, failed to have a codified system of regulations that isn’t dependent on zip code, size of practice, number of employees or type of practice, and have allowed unlicensed dentists to practice for expediency’s sake.

It is no wonder that we can’t accomplish certain changes when we have ceded control of a profession to others. And those that make the rules may not be especially interested in what is best for the profession and for the patients in a unified way.

So as Hurricane Katrina has left, and we are left to rebuild, one has to focus on the problems that occur when our highly fragmented profession has placed so many obstacles in the way of dentists wishing to relocate. Whether it is a personal choice, or due to circumstances beyond their control. Reciprocity is the first issue that comes to my mind because of the devastation that has occurred as the aftermath of Hurricane Katrina. And while this article was written during the most dire news reports, the issues become worth examining no matter how the events of the tragedy play out.

State Standards

Reciprocity is a key issue that has its roots in questions about why different states have different standards of care and try to foster the perception that one state is better than another is.

Why is it that we don’t have one standard for the profession, but instead have various standards?

Why do regulations vary from zip code to zip code, and depend on size of practices, or number of employees, or other basically irrelevant concepts that have nothing to do with the care given to patients?

Are we that caught up with people trying to protect their turf, and trying to do so in ways that make no sense in the long run?

In some regards our profession should take a page from McDonalds. It doesn’t matter where you go. If you see that name, you know that the quality will be the same. It doesn’t vary because of location, size of restaurant, or number of people served.

Quality of Care

The quality of care is a focal point in this discussion. It is the issue that is cited to make reciprocity more difficult, but if one examines the issues of quality of care, one will see that this may be a straw issue.

There are cases of states allowing unlicensed dentists to practice in certain situations on patients. So much for the need of a license or even the appearance of checking for quality of care. There is the issue of states allowing licensed dentists, or dental groups to stay in business when the quality of care is substandard.

So much for the quality of care issue.

But we, as a profession, have sanctioned this substandard care of patients. We have failed to demand quality for all patients. We have been complacent in the problems we want changed by giving a wink and a nod to those offices that harm patients. So while allowing patients to be harmed, and being happy to have the remakes of that poor care, we have harmed the image of our profession.

Will this change? Probably not until we as a profession become proactive to weed out those practices that constantly harm patients.

Allowing substandard care is not how a profession is supposed to maintain their professional standing. Indeed allowing clinically non-acceptable treatment while professing to be concerned about the patient’s safety and quality of treatment leads a non-professional to only see a turf war, not a profession striving for excellence.

It is not acceptable to cast aspersions about the quality of care by others while ignoring the glaring problems in your own backyard.

If we start with the problem of reciprocity, one must ask why a qualified dentist in one state is not accepted by another state. If the issue is quality of care, why do we have individual states setting dental standards rather than the ADA?

This immediately sets the licensing of a dentist as a turf battle where one state can comment that their dentists are better, and keep out others to eliminate some of the potential competition.

While on the issue of quality of care, one must start to question the legitimacy of any dental board examination that doesn’t test what the dentist does and how he treats his patients, especially for a specialist. A general practice board exam, given to a specialist, is not a test of competency, but an attempt to keep a person out. This should have outraged a profession, but it didn’t seem to do so.

The argument has been that the state wants to assure that competent dentists treat patients. So if the issue is quality treatment and the “assumed” protection of the patients, one then has to ask why dental groups that treat in a substandard manner are allowed to keep practicing, even after years of state review indicating that treatment is clinically not acceptable.


What should be the profession’s response to state licensing agencies that know of the problem and continue to license those offices? How long can a profession know of the problems and not be proactive to solve those problems?

Would it make you upset that large groups, treating in a substandard manner are allowed to stay in business because the state wants some place for the patients to be seen?

How long should a group that is treating patients in a non-clinically acceptable manner be allowed to work with the problem?

In one case that I am aware of, the state has been working with the poor quality of treatment given to patients for over 13 years, with the harm continuing. Where is the professional outrage about the abuse of patients? Do you start to understand that allowing the poor quality of care is starting to harm the profession? It sets up a two-tier level of care that must be unacceptable.

When the profession doesn’t step up and do what is proper, others will take the lead, and the result may be that reciprocity doesn’t happen, while substandard quality of care may be the norm. It’s time to change this, especially as we turn more and more into a global community while more and more patients are even looking to seek treatment outside the US.

Reciprocity for Displaced Dentists

As our colleagues are displaced, and may have to find work outside their home state, this has brought this issue into the forefront of issues that need consideration.

Why isn’t a valid dental degree sufficient to practice in any state?

With the devastation of Hurricane Katrina, and the potential displacement of so many colleagues this issue has become critically important, and immediately so. Many of our colleagues may be forced to relocate to different states in order to survive, but will they be able to practice their profession, and do so immediately. Will they be given immediate reciprocity?

Because reciprocity wasn’t the norm in the past we have now placed ourselves in a serious Catch-22 problem. If reciprocity is given to any displaced dentist by another state we must ask why there is a waiver to do so. If we accept reciprocity for financial betterment of the dentist that needs it, that exception would show that the whole problem was a straw issue.

If an exception is given in this case, then the reasoning for not having reciprocity will have been shown to be a bogus one, because then the profession will be dealing with economic need of some colleagues and the issue of public safety will not have been a consideration.

We are caught in a bind. Doing what is right for our colleague brings the issue to a head. Either this is acceptable and hasn’t been allowed or we have lost sight of our patients’ well being to better ourselves. The confusion over this issue will leave our patients to question what is happening. Are we looking out for their best interests or for our own? When patients perceive that we aren’t looking out for them, that is when the profession starts to have problems.

So now we come to Hurricane Katrina and what we as a profession are going to do to help our colleagues get back on their feet, and to earn a living, while practicing their profession. Should we give reciprocity to those dentists whose practices have been destroyed without licensing them? If we do, then we must question why they are qualified because of a disaster, and if feelings are the proper reason to allow this.

If we allow them to practice because we feel their pain, then the whole issue of licensing becomes moot, because a precedent has been set for reciprocity. If we allow them to practice without a license, is that state going to stand behind what they did, by any rationalization?

If the state is going to license them by saying that they are qualified without a license from that state, or that particular board, because they state they are qualified, then we get back to square one of why the dental license isn’t accepted without the paperwork and costs that are now in place.

Protecting the Profession

I have written in past articles that when a profession doesn’t have set standards and doesn’t protect itself and those patients that they treat, then others will come into the vacuum that is created. Those people that start to make the rules and regulations, may not be dentists, and may not have the profession’s best interests, or even the patient’s best interests at heart. When we cede that control to others, we stop becoming a profession and become a trade association. Something that I think that we have studied too long and too hard to strive for, to have taken away by others.

We are being forced to realize that as a profession, we have abdicated our professional responsibility. We have allowed others to dictate what we should be doing, most notably lawyers. Just check to see the language of the dental practice act, and who wrote those laws. Try making sense of HIPPA regulations, or OSHA standards, or even better the absurdity of some of the rules set by CDC.

I especially like the ruling that extracted teeth must be treated as hazardous waste materials and disposed of properly, unless, get ready for this, you give the tooth to the patient. Then the tooth is no longer a hazardous waste material. Can you imagine this scenario in an operating room?

In the wake of the problems with dentistry that have been allowed to flourish, from poor quality to state sanctioned mills that harm patients, to absurd rules and regulations, we have brought a lot of problems to our profession that will continue to emerge as we become more of a global community. We have petty turf squabbles over how many dentists we should license and who we should license. This completely ignores the issue that our profession should not be engaging in trade restrictions, or looking to protect our turf to the detriment of others.

Ever wonder why dental boards are political appointments rather than our profession selecting the best people to serve this capacity? Do you think it might be time to question this practice, and ask if those on dental boards should be political cronies, and fat cat contributors, or the best people possible that can serve the public and our profession?

National and International Dentistry

A story in USA Today mentioned how patients are seeking treatment outside the country because of costs. And the response from the dental establishment was that you get what you pay for, and that the quality of care in the United States is the best in the world.

But aren’t there different fees in different areas of local communities and different states? Can a legitimate argument be made that reciprocity has been a tool to dictate different standards of care in different areas? So shouldn’t a patient be a good consumer and shop for the best price? And aren’t fees different in different areas?

While we say that the quality of care in the United States is the best, aren’t we aware of the fact that there are problems with certain dental “mills” that have been allowed to practice with no particular outrage from the profession about the quality of care that those patients receive in those offices?

The typical dental response is that if you go to a foreign dentist you may have no recourse should a problem arise. That is not much different from the cases not taken by lawyers because the amount of the damages isn’t worth the legal time. It is truly fortunate for the profession that so many dental malpractice cases normally fall out of the realm of cost return that lawyers want.

Or how about the recent case where the patient was harmed, but the lawyer dropped the case just before trial because they found that the dentist had no assets, or insurance?


We should be asking for uniform standards in our global community and uniform standards that quickly and efficiently resolve the problems with poor quality. It is wrong to cast stones about the quality of care in foreign countries, when accepting clinically unacceptable treatment here. It is wrong to claim that there would be no recourse, when that is often the case here.

We should be taking the lead, to show patients that, while mistakes happen, they will be
corrected, and quickly. That would be a profession taking the lead.
I have seen peer review take so long that the statute of limitations can expire while waiting for a ruling. It is also wrong to have the policy for peer review forcing the patient to forego any possible legal solution. That becomes similar to informed consents that force arbitration. It is not a positive way to approach the problems that we have allowed to happen.

Have you ever worked at a dental mill, knowing that you were not doing the best quality that you could, and accepting it?

I remember when 60 Minutes did a program on this issue. The dentist was very smugly telling how bad those clinics were, and that he worked there in order to pick up speed and experience, but he would never work like that again. But nowhere did he take the initiative to inform patients of the problems, or to report the problem to the proper regulatory agencies. So he, and all that know of the problem with the quality of care, are doing their best to create the climate where the profession is harmed.

Ever think that allowing this poor quality may be the reason that we aren’t as strong as we should be? Ever have second thoughts about how our profession sanctions offices that harm patients, while we smugly practice in our private offices, willing to do the remake on these patients, but not willing to correct the problem? Ever wonder if this attitude is what has caused consumer groups to start to question what happens in our offices, and lobby for changes to be made?

In California there was a guest worker program being established which would allow non-licensed dentists to come into California to treat the large Mexican population. The allegation was that this population wasn’t getting proper treatment. Seemed that in the discussion to allow this, the state was making the argument that California-licensed dentists were not being sensitive enough to the dental needs of those that weren’t American citizens.

So a breach in the licensing requirement was being made, while the profession remained strangely silent. This type of agreement, which allows unlicensed dentists to treat patients, but won’t give a licensed dentist reciprocity, is a dual system that should have the profession up in arms. As should the concept that California dentists don’t have the sensibilities to treat the Hispanic population.

In Arizona, I recall that dentists that didn’t want to be in private practice could opt out of having to get an Arizona license if they were to only practice in state-run dental clinics, and accept a much lower form of compensation.

While not as egregious as the California situation, consider what the state is saying: “You don’t need a state license if you are going to treat the poor, but if you are going to treat paying patients you must be licensed.”

Either the dentist is qualified or he isn’t, but to make the determination based on the income of the patient, has already set up the two-tier level of treatment that should be abhorrent to all professionals.

Australia allows assistants to place amalgams, but only on children. Are the assistants qualified or are they not? Or is there a difference in the teeth of children when compared with adults? Different standards, based on obscure reasoning and based on monetary concerns, should be a red flag.

Two Tier Treatment

Does this mean that the two-tier level of treatment is being created by de facto arrangements that the profession is not a party to and are these two-tier levels of care becoming the norm?

This reminds me of the situation that should you have HMO type plans to fill in your empty time, you may have created a two-tier level of treatment in your office. That could create a serious nightmare, if and when it gets shown that you don’t treat all with the same skill, care, and in the same timely manner.

We may already be going into an interesting direction where licensing will be done by post dental internships. New York has a new requirement that an internship is needed after dental school, replacing the licensing examination.

Is the standard of care going to be the internship after dental school, to replace dental boards, and will that be done in all states?

This program raises the specter of where all these programs will be held, and will all dentists be able to get into a program. If you add the number of dentists to a location, have you artificially created, by government mandate, an adverse economic condition for all those that are already practicing? And what do you do if there is no internship program in a state, or there is not access to the program? Will we now have a two-tier level for licensing and for those with an internship and those taking boards? Will foreign dentists that want to practice here also have to apply for the intern program?

The Bigger Issue

In any case, the bigger issue should be what do we do about reciprocity, and how do we handle it in a timely manner so that we don’t have to face these decisions in time of a crisis. What are we going to do to bring the rest of the global dental community into conformity with standards that are being established? Isn’t it time to get rid of the notion that our profession is a profession that has different standards based on where we choose to practice?

We are in interesting times, and again, because we as a profession have stuck our collective heads in the sand, events are dictating to us, what should have been the profession taking care of their patients and their profession.

While centering my discussion around the events caused by Hurricane Katrina and offering prayers and support for all those affected, we should also be sending our prayers to our colleagues in Mumbai, India. In July that community suffered severe flooding that killed more than a thousand people. They also are looking at an estimated $690 Million to repair the structural damages done by that flooding.

(Contributing writer Dr. Barry Levy is a dental consultant, lecturer and is on the California Dental Board’s panel of expert witnesses for dental board investigations)

Direct Reimbursement Plans: A trend waiting to happen

by Craig Beauchamp

Direct Reimbursement Plans (DRP) may be the upcoming trend to provide for one’s dental care needs, while at the same time letting many dentists regain control of their profession and get the financial compensation they deserve for their work.

The North Carolina Dental Society’s website states, “…dental care costs are predictable and non-catastrophic.”

Catastrophes fall under medical insurance and can not be planned for. Therefore, requiring the use of insurance companies to level the playing field by spreading the need for large medical payments over a larger population that pays, simply, for a maybe.

The fact is dental insurance funnels money out of your community and country, while at the same time taking control of the art of dentistry away from the dentist. It forces many dentists to work for less than they’re worth, adding to extra work load and stress while decreasing profit margins. This doesn’t even address the suppressed level of preventative care the average patient and his family receives, or needs, from his dentist to keep healthy teeth and gums.

With DRP, the money that a company would spend on insurance is put into an account that is set aside, accumulating interest, to be used as the employee sees fit. What is not used stays in the account collecting interest for the administration costs of the DR plan instead of for the insurance company. The patient and dentist have control of when and how it’s used. Of course the specifics of each plan differ depending on the company, but when informed of the savings and the increased oral health care and morale of employees, it only makes sense for more companies to start their own direct reimbursement plans.

The problem arises in the marketing. Insurance companies place a huge amount of their overhead into marketing. DR plans do not have that overhead, resulting in a lack of information and promotion on the subject. Many dentists say they feel that DR plans can’t succeed because of this.

Some DR plans require the patient to pay out of his own pocket and get reimbursed when they show their receipt. Some companies have given their employees with DR plans a debit card that has a certain amount allotted to it that will immediately be paid like any other debit card.

For the dentist this is fee for service, for the patient it is managed oral health, and for the company providing it there are multiple benefits. These range from increased production from healthier and happier staff to the knowledge that they are keeping money in their community. Some of that money will then come back to the doctors through the services they provide and even direct savings on the fees they have to pay to provide a good dental care program to their employees.
According to Dr. Keith Lever of Utah, “There is … higher case acceptance with direct reimbursement.”

Proper dental care and upkeep can allow a person to plan, with the knowledge and expertise of his dentist, for a healthy oral state. Even some level of cosmetics can be handled, such as braces.

Since there are no exclusions in a direct reimbursement plan, dentists and their clients can effectively plan a treatment plan that is approved by the expert; the dentist.

When asked why DR plans haven’t taken off better some dentists pointed out that it is in direct competition with insurance companies which spend millions a year in advertising. DR plans save money partly because there isn’t that marketing overhead. Yet because of it, companies don’t hear much about it.

This means that you have to go out there and create them!

Go get large companies, or small ones, the literature and build relationships with those companies that are in your community. Find out how many people they employ and do a mock up plan for them!

Dr. Andrew Lazaris of Plano, Texas said, “DR plans are great, but we need more employers to take part.”

The North Carolina Dental Society, the Utah Dental Association, the Illinois State Dental Society, and the ADA all have information available. The ADA can be contacted at 800-232-1890 or by e-mail at

There is also a list of third party administrators (TPA) that handle DR plans available from the ADA and state dental societies who can provide information on how to market DR plans.

Getting New Patients: A Practice Management Mantra

Doctors all over the country and the world are still trying to figure out, “How can I get more new patients?”

The quest for new patients or customers is not indigenous to the medical professions. Every business is looking to find more people to buy their wares or sell their services to. We all know that word-of-mouth is the most effective marketing available.

All of the trillions of dollars spent by Coca-Cola, General Electric, IBM and the myriad other major corporations is only worthwhile due to excellent word-of-mouth created by satisfied customers. If Coke tasted like a typewriter, the company would be in big trouble no matter how much it spent on advertising.

Advertising is really only as effective as the product’s quality. If you have a lousy product, no amount of advertising will keep you alive. There is the oft-cited case of unleashed a tremendous advertising campaign utilizing a very recognizable pitchman, the Sock Puppet. But didn’t create a valuable, exchangeable product that would garner an excellent word-of-mouth reputation. And away it went into the nether regions of Internet Valhalla.

The point I’m making is simply that there are easy tools available to build an excellent reputation without sacrificing one’s standards or violating professional guidelines.

This quarter’s edition of Solutions will focus a bit on marketing solutions and building that word-of-mouth practice you should have.

You’ve invested too much time and money into your training to allow your lack of knowledge in marketing your practice make you poor.

Cory Radosevich
Managing Editor

The Practice Solution Magazine

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Guest Column: By Dr. Barry Levy DDS


By: Dr. Barry Levy DDS

If you are not aware of, or are not complying with minimum standards of infection control, you can be in for a rude awakening. While the below article addresses cases litigated in California, it is important for dentists across the country to understand many precedents are set in California and can affect how you practice dentistry in your home state.

Recently the California Dental Board cited section 1005 of the California Profession and Business code in a disciplinary action against a dentist (Section 1005 defines “minimum standards” of infection control to be followed while practicing). Because of the dentist’s failure to follow the minimum standards of infection control the board hearing was being used to determine if this dentist would be able to continue to practice dentistry. Penalties could range from fines, to suspension, to revocation of one’s license. It is easy to see the impact that the failure to follow minimum standards of infection control could have on your life should a problem arise and the board decides to investigate how you practice.

A recent malpractice case was brought against two dentists, because of a post-operative infection following an extraction. This case should drive home this concern and show how critical the language in the dental code is.

A large law firm was handling this case for the patient. After a year of negotiations the firm told the patient that they were dropping the case because they could not link the treatment to the post-operative infection. The judge allowed the patient time to find a new attorney. The new attorney took the case and, even with no way to link the infection to the treatment, won a settlement.

So why did the dentists’ lawyers settle this case after getting a law firm to drop out?

The lawyers for the dentists settled this case rather than risk trial, because the liability was too great. It was impossible to defend the position that a post-operative infection was not the dentists’ responsibility when they failed to follow the minimum standards of infection control when treating this patient.

A dentist cannot afford to litigate when he has FAILED to follow minimum standards of infection control and his patient winds up with a post-operative infection. A jury would hear the failure to follow the minimum standards as proof of negligence. A dentist could not argue that he didn’t know the code. Ignorance of the law is no excuse. And, in California, a course in infection control must be taken in order to renew one’s license.

Of particular importance is the language of the code section that states, “Sterile gloves shall be worn in connection with surgical procedures involving soft tissue and bone.” That can be taken to include periodontal treatment, extractions, endodontic treatment and, indeed, almost all of dentistry. Sterile gloves are not the medical exam gloves that are currently being used.

Should a complaint be filed, or legal action pursued against a dentist, the failure to follow the minimum standards are easily proven, and worse, could be shown to be occurring on an ongoing basis. In the civil case, the deposition of the dentist took about 20 minutes. The settlement was large.

The questions were very simple. “What size glove do you wear? Do all of your staff wear gloves? Do these gloves come in boxes of 100? Are you familiar with code section 1005?”

The answers of “large”, “yes”, “yes” and “no” were all that was needed to show the negligence. There were no questions directed to how the patient was treated, or what was done, or to try and link the treatment to the infection. These simple questions and unambiguous answers locked this dentist into negligence by failing to follow the code section.

The continued and ongoing failure to properly follow minimum standards of infection control could change a simple act of negligence into continuous acts of negligence.

My experience with the California Dental Board is that one act of negligence is treated very differently than continued acts of negligence.

If a dentist wasn’t using “sterile gloves” for one patient, the odds are very high that a thorough investigation would prove that all patients were at similar risk. The lone act of negligence would immediately become continued negligence.

But because of recent court action the stakes have risen even higher. It is bad enough to be sued in civil court, and facing a dental board investigation is a horrendous experience, but the precedent has been set so that criminal proceedings could be brought against you.

Should dentists fail to follow the minimum standards of infection control, and should they treat children, they will have met the minimum letter of the law that could see them charged with felony child endangerment (penal code 273 (a) a). This was the precedent that was set in the Dr. Ford case.

The Dr. Ford case involved sedation of a 15 year-old patient, who suffered a heart attack and brain damage in the dental office. This injury to the patient was deemed by a lawyer in the Attorney General’s office to be a criminal act. In the preliminary hearing, the judge, having heard the evidence, ruled that placing a child in a situation where there is a probability of harm, EVEN if no harm occurs, and knowing the consequences of your action rises to the letter of the law for criminal prosecution. There are now some lawyers who believe that an informed consent form is proof that the letter of the law for prosecution has been met.

Dr. Ford was exonerated of all charges against her, but the precedent had been set. It becomes easy to see that failing to follow the minimum standards of infection control could easily meet the letter of the law as applied in the Dr. Ford case, not to mention negligence, defined in black and white.

If you fail to follow “Minimum Standards” of infection control you have definitely placed your patient in a situation where there is a probability of harm, even if no harm has occurred and you are aware of the consequences of your action.

When the state was prosecuting Dr. Ford they argued that guidelines were not followed. They didn’t argue that minimum standards had been violated, because in this case the minimum standards weren’t. Having an unsatisfactory result when not following guidelines can be argued, and argued successfully, by showing that the standard of care in the community was met. Failing to follow a minimum standard can never be argued in that manner and, indeed, the standard of care in the community would be irrelevant in your defense.


We can throw in the interesting aspect of dental amalgam just to show how this can be applied as well, once a precedent is set. While the American Dental Association continues to argue that amalgam is perfectly safe, some dentists in California settled a lawsuit involving amalgam restorations.

In this lawsuit the dentists paid a settlement, and the settlement stated that the use of amalgam poses a health risk to the patient. The settlement even included the language that the use of amalgam in children under age six is contraindicated.

So using amalgam could cause a problem as the precedent has been set that placing a child in a situation where there is a probability of harm, even if none occurs, and knowing the risks can be viewed as rising to the letter of the law for criminal prosecution.

Pending federal legislation even cites the California settlement in the language of that bill. Certain consumer groups have gone on record to state that the use of amalgam should be a criminal act. It would not be a far leap that at some time in the future a test case might be filed. To say that this could never happen is what the profession had said in the Dr. Ford case.

But once the precedent is set, the argument that it could never happen can no longer be used.

What we are finding is that small, very vocal groups of consumer advocates are pushing legislation that can be very harmful for the way you practice and for your fiscal health. The problem is that once these groups get the legislation passed, the precedent is set and you may find that you have to follow these regulations in order to practice in a manner that mitigates possible civil, board or even criminal action.

Intelligent and learned dentists may argue that some of the precautions are not really necessary. When the new regulations are defined as minimum standards for the care of the patient, when certain materials are defined as potentially harmful, and when precedent has been set by cases that have been tried, your ability to defend yourself becomes more difficult if not impossible, should a problem occur.

I hope that this brief article that started out with the issue of infection control, has been informative. These situations can have a profound effect on you should a complaint or lawsuit ever be initiated against you. We are entering a new era for dentists, and it is becoming increasingly more important that you are aware and practicing within the letter of the law.

I strongly believe that the dental profession must take strong steps to regulate and protect their profession. When dentists get so involved that they don’t, then others make the rules and regulations that you must follow.

And because time is money, I want to finish with the cost to you should the California regulations come to apply to your state.

If you have to change one box of gloves each week to sterile gloves to comply with the minimum standards of infection control, the cost is over $3000/year. A busy practice using 5-10 boxes a week would be looking at an increase in cost of $15-30,000/year for sterile gloves.

(Dr. Levy has served as an expert on several cases, and is on the California Board of Dental Examiners panel of expert witnesses to assist in investigations)

Preferred Provider? by Dr. Charles S. Horn, III, DDS

Interview concerning Practice Management with Dr. Charles S Horn

Some months back, we did an interview concerning practice management with Dr. Charles S. Horn. At the end of that interview, Dr. Horn told us about a letter he had written concerning working with insurance companies. He asked if we would like to look at it and possibly include it in our next issue. He sent it to us and we found it so “to the point” concerning the state of managed care today that we are including it in this issue of The Practice Solution Magazine. We hope you enjoy it as much as we do.




Dear Mr./Mrs. Insurance Company:

I read your letter with great interest. I am indeed honored to learn that I have been singled out of all the fine dentists in Delaware, by one of the fastest growing companies in the country, to be asked to join your health care organization. From the tone of your letter, it is humbling, indeed, to learn that I am one of the best and I am excited to hear about all the new patients that you assure me, will be flocking to my office. Though you mentioned something about my name on some sort of a list, I am sure it is a very short list and all of these patients will be coming to me. You asked me if I wanted a lot of new patients and then answered your own question by saying that I would get many new patients. I can hardly wait to greet these new people, eager to experience new and extensive dentistry, as you promised.

Your fee schedule was a little disappointing, since it seems you will be paying me about 40% less than I usually charge, but that’s OK, because of all the new patients I will be seeing. Considering all these wonderful things you will be doing for me, I feel compelled to ask a favor of you. Since my income will be cut by 40%, I must ask you to send a personal letter (not a form letter) to all the laboratories I deal with. This letter must inform them that I will discount their bills by 40% and not pay their normal charges; also a letter to all my supply houses (the names and addresses are enclosed on a separate sheet). My repair man may be upset, but, with the increased use of equipment, he will be called more often. You must be very tactful when you write to my wife, because, with a 40% cut, she will also have to cut back. My employees may be upset with a 40% pay cut, but, since we will be working so many extra hours with crown and bridge, precision partials and implants, they will not mind, I am sure. My accountant should understand since she will see from our records that we will be working longer hours yet producing less income, but that will be her problem. I will, of course, have to cut back on my vacation time since I will be spending more time in the office (with 40% less in fees). However, I could hire an associate at 40% less than the going rate, but he/she should understand. Our hygienist will have to cut down her appointment time from 1 hour or 45 minutes to 30 minutes, but I am sure she won’t mind. I think 30 minutes should be enough time to do a good prophylaxis, give oral hygiene instruction, take the necessary radiographs, answer questions and for me to do a thorough examination, a cancer exam, answer more questions and make the necessary recommendations.

With all these new patients, we will just have to work faster. With less time between patients, we will have to find short-cuts with our sterilization procedures, but if nobody gets sick or infected, I’m sure OSHA might not notice. We will no longer have time to establish a “dentist-patient” relationship, but that’s OK; with the increased volume, it will not matter that much anymore if we really get to know each patient. The patients might notice, but after all, they will be coming to me for cheap fees and average dentistry and that is what counts, isn’t it? Cheap dentistry? This should make up for the personal time I used to spend with them.

When I went into dentistry many years ago, I wanted to be my own boss and make my own decisions. I understand that if I work for you, (as an employee of some sort), you will take care of me and help me out whenever you can. It will be reassuring to know that I will not have to make my own decisions anymore, about fees and those kinds of things, because you will make those decisions for me. When I read your “Participating Dentist Professional Service Agreement”, some things were just a little confusing. I am sure this “agreement” is in my best interest and you only have me at heart because you want to help me, my patients and your clients. After 30 years of dentistry and my patients calling me “Doctor”, you want to call me only a “provider”. My son is a provider for his dog. Would it be OK with you if I still call myself “Doctor” around my friends and only go by “Provider” with all the patients you will send me? Your contract also goes on to state that I can only refer to one of your member specialists or, if there are none, I must give you notice and get your permission. Does this mean that I have to get your permission before I am allowed to send a patient who is in pain, with a swollen face and a highly infected molar to an endodontist at 4:30 on Friday afternoon? On the leader page that you sent me, you stated “No Paperwork Required from Plan Dentist”, then on your “Service Agreement”, you state “Dentist will provide patient utilization information to (the plan) on forms provided by (the plan) or on such other forms as agreed to between the parties”. My question is… “Are there forms or no forms?” Also, you state that you can inspect any books and documents relating to the dental care services rendered… I assume this also means that I can come to your office and “inspect any books and documents relating to the dental care services rendered”.

I received a letter today, at my home in Pennsylvania, from your company. This letter stated that I can automatically be accepted to your dental plan because I own a certain credit card. It is obvious that the person sending me this letter did not know that I was also a dentist. I noticed, however, that everything you stated in the “credit card letter” does not seem to fit with what you say in your “Dental” letter. The most misleading statement is… “every (dentist) has been extensively prescreened and approved according to our (your) high quality standards”. Your “high quality standards” are… my fax number, my degree, number of dentists and hygienists, number of operatories, do I carry malpractice insurance, my office hours, languages spoken, and my date of birth. I would not consider these high quality standards. It is interesting to know that you consider “high quality standards”, but what about the rest of the card holders? I wonder what they would consider “high quality standards”? All the letter to the card holders talks about it “no charge”, “savings”, “reduced cost”, etc. Whatever happened to caring, good dentistry, cheerful, honesty, truthful, high tech, value, improved care, understanding, listening to patients and, sometimes, free dentistry for people who cannot really afford good dentistry. With you, it all seems to come down to money, not good dental care or a caring dentist, just your bottom line profit.

After writing this letter, I think it would be in the best interest of my patients, my staff, my wife, my laboratories, my suppliers, my accountant, my associates and, yes, even myself, if I just continue doing dentistry the way I have done in the past and the way I want to do it in the future. I might not need all the wonderful things you can do for me or even all the patients you promised. I like the kind of high quality dentistry I have been doing and I do not think I should lower my standards to just adequate care for discounted fees. You can, therefore, keep your forms, cut-rate fees and “Big Brother” tactics. I think I will be happier the way I am… a dentist doing the best dentistry I know how, the way I think it should be done, referring to top rank specialists who do not have to get on a list and being my own man, making my own decisions without someone looking over my shoulder. I also am happy charging what I would consider a reasonable fee without cutting prices so that an insurance company can increase its bottom line profit.

At the fees you quoted, my employees will be making more money than I will. Please do not attempt to contact me in the future, because your literature and that of other insurance companies like yours, is cluttering up my trash can.

Very truly yours,
Charles S. Horn, III, DDS