PROFILE: Dr. Kathleen Bartos and Lou Bartos

How did Halifax Veterinary Clinic go from $0 in collections to over $1 million a year?


Dr. Kathleen Bartos and Lou Bartos

Practice: Halifax Veterinary Clinic

Location: Port Orange, Florida

A general small animal veterinarian, who specializes in veterinary acupuncture, Dr. Kathleen Bartos opened her clinic in July of 1990. Together with her husband Lou as office manager, the Halifax Veterinary Clinic struggled badly for the next five months. By December, they had $0 in collections. That’s right – $0.

Dr. Bartos had graduated from the University of Florida veterinary school in 1986. She worked as an associate for two and a half years and then did relief work for other veterinarians for a year and a half while attempting to build her own practice.

She thought she had the necessary tools to succeed.

But in December of 1990, on the verge of bankruptcy, she and Lou had a serious dilemma: do they invest in the practice more or do they shut down?

Due to Dr. Bartos’ strong desire to help animals, shutting down was clearly not an option.

The Bartos’ quickly decided that they needed help in managing their practice so they hired practice management consultants.

The first piece of advice they were given was to promote the practice and to promote without delay. Since it was December, they sent out holiday specific promotion and, within a month, things swiftly started changing for the better.

Within two months, the Bartos’ had received a 100% return on their investment in the program.

Fifteen years later, Halifax Veterinary Clinic produces over $1 million a year. It has its own in-house blood lab and Dr. Bartos has developed an incredible reputation as an excellent practitioner of veterinary acupuncture.

Even with their great success, The Bartos’ still use consulting services.

“It’s like going to church, if you stop going you feel like you’re missing something. And when we have new staff, we have to get them trained,” said Dr. Bartos. “It’s a successful action,” said Lou.

It may seem like the Bartos’ would have to work all the time in order to be this productive. Not true. They only work 4 days a week giving them plenty of opportunities to enjoy their hobbies of kayaking, hiking and spending time outdoors in other activities. They also have 5 cats and a dog.

At the end of the interview, Dr. Bartos had some advice for veterinarians just graduating. She said, “Don’t miss out on general practice by being a specialist, go into progressive, high quality general practices that are willing to innovate.”

PROFILE: Dr. Tommasina Pasqua

Fresh Out of School Michigan Optometrist goes from $84,000 to $425,000 in 3 years!


Dr. Tommasina Pasqua

Practice: Harrisville Eye Care

Location: Harrisville, Michigan

A 1998 Dean’s List graduate of the Michigan School of Optometry at Ferris State University, Dr. Tommasina Pasqua opened her office right out of school while also being employed at an ophthalmology practice.

During her first 3 years in practice she worked part-time at her practice and was producing $80,000 per year, which is very respectable for a starting part-time practice.

However, her accounts receivable was out of control and she didn’t have the time to put things to rights due to working all the time. She was having problems with staff members, felt that she was stuck in an old building and that she should be seeing more patients. Not only that, she had a newborn to take care of.

With all of these issues weighing her down, Dr. Pasqua decided to hire practice management consultants to put some order in. This was in 2002. Within 8 months of hiring her consultants, Dr. Pasqua had recouped her investment. She currently is working full-time, seeing patients 4 days a week and made $425,000 in production last year. That is a 500% rise over only 2 years!

“I’m continuing with my consultants because I want to take my practice to the next level and increase my net. I want to start a second practice and buy excellent equipment to better service my patients,” said Dr. Pasqua, “Currently, I’m getting guidance in financial planning. Each course I take causes my statistics to go up.”

She said, “Right now, delivery is great and I like giving my undivided attention to one-on-one patient care. To be honest, I especially like the fashion aspect of optometry. I like helping people with frame selection because it makes them feel good when they find the frame they love.”

Building the practice has enabled Dr. Pasqua to participate more in local activities. She recently accepted a position on the board of Tawas St. Joseph Hospital. She has very diverse interests. In the past she was a music instructor for elementary school students, plays the organ and has a high interest in music theory. Not only that, she is a certified aerobics instructor with a passion for traveling. Her favorite travel destinations are Puerto Vallarta, Mexico; Portland, Oregon; and Southern Italy.

“Anyone starting their first optometry practice should start with training from a practice management company. This is a business and if you don’t know what to do, you can’t pay the bills,” recommended Dr. Pasqua.

Haas School of Business and Optometry Join for Business Plan

BERKELEY /Ute Frey, UC Berkeley/- Optometry students at the University of California, Berkeley, are getting a leg up in basic business skills from Haas School of Business faculty as part of a special program to prepare future optometrists to manage a private practice.

Workshops in the new Executive Eye Care Business Program, a new collaboration between the Haas School and the School of Optometry, began aiming to sharpen the business skills of eye care professionals and better prepare them to run their own private practices after graduation.

“There is an often unrecognized need for management skills in non-corporate environments,” said Andy Shogan, associate dean for instruction at the Haas School. “Similar to our Management of Technology collaboration with the College of Engineering and our concurrent degree programs with the School of Public Health and School of Law (Boalt Hall), this is an example of Haas leveraging its expertise to help another discipline interested in elevating the business savvy of its practitioners.”

The response from the students has been outstanding. Over 90 percent of third-year optometry students, plus many of the available fourth-year students, are participating in the workshops, which consist of nine instruction sections delivered over 12 weeks. Each section features an instructor and an advising consultant, roles shared by faculty from the Haas School and the School of Optometry.

Haas School instructors include Professor Jonathan Leonard on human resources management; Professor David Vogel on ethics; Assistant Professor Thomas Davidoff on microeconomics; and lecturer David Robinson on marketing. Serving as advisers are Professor Candace Yano on operations management; Assistant Professor Thomas Davidoff on personal finance; Visiting Associate Professor Godwin Wong on entrepreneurship; and lecturers Rada Brooks on accounting/finance and Alan Ross on business law.
Classes are not for credit and are free to participating students, who must fit the additional coursework in with their existing studies. The School of Optometry is funding the program, with corporate support from Vision Service Plan, Alcon, and Vision West, Inc.

“While the primary thrust for any medical practitioner is giving top quality care to patients, this can only be sustained if a medical practice is also a going concern,” said Dr. Robert DiMartino, chair of the faculty for the School of Optometry and an associate professor of clinical optometry.

“We already have a reputation as a leading optometry school, training people to be the best eye care providers they can be,” he said. “Now, we’d like to widen their options by giving them the tools to be medical providers who can also be successful in an entrepreneurial venture or as a partner in a private practice.”

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