Tuesday, June 22, 2010

Dental Hygienist Compensation Question

I opened my practice in central Maryland 3 months ago. We have been growing like crazy. I am seeing about 6 or 7 new patients a day. The only problem with this is I have no time for dentistry, as all I do is new patient exams, prophies and scalings. We are booked out almost till the end of June (about 4 weeks). I am ready to hire a hygienist.

I put an ad on craigslist for a hygienist and received several applications. At first I wanted to hire an experienced hygienist, but ALL of the applications I received from experienced hygienists were clearly just looking for a higher paycheck, and not for a better workplace. I actually had one hygienist write in her cover letter, "I may not even want to work for you; I just want to see what my options are." I do not want to hire someone just in it for the money.

I also received several applications from very recent hygiene school graduates. They are enthusiastic and excited for the new opportunity. I decided I would interview the new grads and see what they were like. Obviously, they have no experience and are going to be slow at first, but I was impressed by their enthusiasm. I want to hire someone who can grow with the practice, and stay long term. I want to hire someone willing to work part time at first, and then, if they work out well, work full time.

My question is: how much should I offer to pay these new graduates? One asked for $34-38 per hour. That seemed on the high-end to me, but maybe I am not realistic. What types of salary are you paying your hygienists? What I was thinking about doing is paying them a lower rate for a 90 day trial period, and if they work out well, bumping up their salary and hours. What do you think of that type of setup? I am concerned about paying on production because we participate with several PPOs, and I do not want to lose money hiring a hygienist. Do you offer your hygienists benefits, like vacation/sick time, health-care or a retirement plan?


Paying $34-38 per hour is LOW from what I've seen here in MD over the past 5+ years. If you were to ask what you should expect to pay I would have replied $40-45 per hour. That's actually lower than what I would have replied with about 1-2 years ago.

...Last piece, the rule of thumb in terms of hygiene pay is that they should be compensated about 25%-30% of what they produce per hour.

…as a ratio this equates to the hygienist producing 3-4 times what they are paid. Here in this tri-state area (MD\DC\NOVA) while this ratio held true more than 7+ years ago, the ratio averages about 2.7 times what they're paid these days. This is because hygienist compensation has increased sharply over the last 5-7 years in this area.

Again, the 2.7 times their compensation for their production is an average. There are practices doing 3.5-4 times their compensation (not many though) just like there are practices doing 2-2.5 times their compensation.

So if you can get your statistics for their compensation in the range of 30-40% of their production, you're doing pretty well. Getting it below 30% and you're doing great...at least in this tri-state area.

Thanks for all of the advice! I interviewed a bunch of candidates and one candidate just seemed to gel with the office from the moment she walked in. Her references spoke extremely highly of her. We just called and offered her the job and she was ecstatic. She is going to work 2 days a week until we are busy enough to have her work more, and then I'll have her work 4 or 5 days a week. I am excited and hope she works out well.

The anticipation is killing me, were the ranges of compensation close?

I am paying her $34 an hour. I am buying her an LED light for her loupes, which I guess you could call a benefit. There are no other benefits other than that, although I guess working with me in my awesome practice, with my great equipment and staff is a benefit. In a year or so, when I set up a retirement plan for myself, I will get something that I can offer to all my employees. She said she did not want health insurance, due to her spouse having it, so we are good on that. I didn't mention it to her, but I am a strong proponent of CE, and will probably take my entire staff to things now and then so that is a benefit as well.

Thanks for the feedback, very helpful. You did VERY well!

This first appeared on Dentaltown.

Send your questions to Tim Lott, CPA, CVA at tlott@dentalcpas.com

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Friday, June 11, 2010

Acquiring a Dental Practice and Merging it into an Existing Practice

I have an opportunity to purchase an existing dental office that is 3 miles away. The doctor is in her 60's and is willing to sell and work in my office 2 days a week. Time frame for her to exit the office will have to be evaluated. It is a FFS office with no PPO, similar to mine with an exception that I am a provider to Delta Premier and United Concordia. She is willing to share her numbers before meeting with the broker to see if it is feasible for us to pursue. Any advice what to ask and look for?

You should have her run reports of patients that have those providers to see if any of them will be able to use them in your office. Then get a breakdown of production by provider to see how much additional hygiene hours you'll need. Once you do that, get a list of her employees and their hourly rates and find out what benefits she may pay to compare with yours. You'll also have to compare vacation days given, etc, and compare with yours. If you hire any of her employees, the compensation packages, benefits and PTO days will have to match. You will need to evaluate the fee schedules and find out if you do any procedures she doesn't and vice versa.

These are just a few things off the top of my head.

Thanks Tim for your responses. She wants to practice with us 2 days a week. Will the purchase price be lower or higher than a typical practice acquisition without the dr staying on?

The price should be less than the typical acquisition where you're also buying tangible assets and the space.

I can't say I've noticed differences in prices with or without the doctor staying. That's up to the parties and I just haven't seen it used as a negotiation point in the majority of the deals I'm involved with.

All that said, you certainly stand to retain much more of the patients with the seller staying on board and assisting with her GW transfer as opposed to having her out immediately.

This first appeared on Dentaltown.

Send your questions to Tim Lott, CPA, CVA at tlott@dentalcpas.com

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Wednesday, June 9, 2010

Capital Versus Debt – What is the Difference?

Here is an interesting article by Richard Sinclair, a friend of our firm.

In the entrepreneurial world of small business, capital, business risk and credit risk can all be easily misunderstood.

One of the reasons companies succeed or fail is due to capital, also known as equity. Whether a business is funded by its owner(s), angel investors or bankers, business risk and credit risk are very different and must be understood to obtain funding.

What Is Business Risk?

According to Jim Hogan, of J. L. Hogan & Associates LLC, a commercial lender with 30 years' experience, business risk is market risk. When a banker considers a loan, a stream of income or revenue is needed to repay the loan. Since cash flow services the debt, a conventional commercial loan is not usually the best avenue for new or young entrepreneurs because their business model is not proven to be viable.

Understanding capital versus debt will take a new business owner far in his goal to success.

For instance, a national company recently sold its local small candy manufacturing division. The buyer was an individual from outside the company. She desired the platform because, in the future, she wanted to convert the candy company into a specialty pharmaceutical manufacturer, an area where she had some experience.

The buyer capitalized the candy company with cash from her retirement fund and money from friends and family. The deal got sweeter because of a seller "take-back note" on machinery and equipment and a rent moratorium for 90 days from the landlord. In addition, some customer accounts were retained, and therefore, the company generated modest revenue from the beginning.

Yet the monthly cash generated was not sufficient to cover the operating costs of the business. As such, the company would have been out of cash in seven months. The company moved quickly to build additional sales, collect on those sales it made and reduce its shortfall. Within months, the shortfall had dropped and the company had sufficient remaining capital (equity) to continue for more than 20 months. But the goal was to become profitable, not just stay afloat. With a few additional sales, the candy company's positive cash flow was within its grasp.

What Is Credit Risk?

Tim Lewis of Chesapeake Corporate Advisors says credit risk is a funding risk that lenders take, intended to cover a timing difference in a business's operating cycle, such as when a company makes a sale and is waiting for payment while it simultaneously has to pay operating expenses.

Credit risk is the timing risk of business assets converting to cash - for instance, accounts receivable. Credit risk should not be the risk of business failure, and credit risk is not rewarded like business risk. Credit risk is rewarded with a reasonable return, but never a large payout to the lender.

A lender will loan on a credit risk, for example, when it knows it has a receivable. The lender then becomes the entity that funds timing differences between the sale of the product and the collection of cash. It might be an inventory conversion cycle in which there is a conversion to a sold product for cash or generating accounts receivable. The business will use all its assets as collateral for funding, and for small businesses, the business owner will also provide a personal guarantee.

The most important thing to remember about credit risk is that capital needs to precede debt. Let's say a local entrepreneur wanted funding for the development, manufacturing and sales of his unique gloves and heated bike riding apparel. He has had some success in the regional biking market, based on his own minor investment, but showed no retained earnings. He wanted to grow his company, and while the finance community could see his business potential, the risk at this early stage was of the business succeeding (business risk), not the risk of the conversion cycle. As such, he was dissatisfied with lenders that were unwilling to finance his marketing efforts to grow his business.

What's the Difference?

Why was the candy manufacturer successful in finding a line of credit while the glove and apparel manufacturer was not successful in finding a loan? The answer again is capital.

In the candy manufacturing deal, the entrepreneur takes the business risk through cashing in her retirement and the investment of her friends and family. She also had cash equity in the game, taking the risk of business success or failure. If the business fails, the entrepreneur, friends and family lose. They may lose all of their investment. But, if the candy company is highly successful, the investors can win many times their original investment. The lender knows that the equity is there and at risk before the loan. The lender takes a credit risk, not a business risk.

The biking entrepreneur failed the business risk test because the lender was being asked to take the equity risk of a successful marketing campaign funded by the lender, not the credit risk of the asset conversion cycle.

Why Does It Matter?

"Business risk underlies credit risk," quips Lewis. "When a business owner embarks on a new venture, he or she is assuming whether or not the business will succeed or fail."

The responsible business owner needs to identify funding sources, and he needs to take his product or service from the concept phase to something that is generating value and profit.

That is when a lender can come in to play. A traditional banker does not take business risk, but does take credit risk. The lender will be there to finance the asset conversion cycle, but not to take an equity level risk or get an equity level return.

Equity should be there to protect the debt and help the business grow. The successful entrepreneur may want to sell his or her business in the future, hopefully for many times his or her equity investment.

Before entrepreneurs go to the bank for a business loan, they should ask themselves, "What kind of risk is this, business (equity) or credit (moving business assets through the conversion cycle)?" The answer is their guide.

Richard Sinclair is president of Correspondent Business Credit, a company meeting the alternative financing needs of small businesses in the Chesapeake region through asset based lending. He can be reached at 888-849-4222, ext. 19.

This first appeared in The Business Monthly

Send your questions to Tim Lott, CPA, CVA at tlott@dentalcpas.com

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Monday, June 7, 2010

Should Dentist Start a 401k Plan?

I met with our local Edward Jones Financial consultant thinking it would be wise to start a 401K. After going over my financials, he recommended that I consider a safe harbor 401K versus the traditional 401K.

After digesting all the information and running numbers, I just don't seem to get it.

I understand you contribute pre-tax dollars to fund your retirement, but you also must take into consideration a match for your employees. If you add profit sharing then everyone gets a piece of the action whether or not your employee chooses to match. If you want to add define benefit plan option to your 401K, then you can channel quite a bit more funding but in the end it still ends up divvied up like profit sharing. That's a lot of money not including administration costs and management fees. Also your money is locked up with penalties for early withdrawal, not to mention more administration headaches. There is also the fear of the unknown when it’s time to take it out if you make it to the qualifying age!

I keep doing the math but I can't figure out.

Can you please shed some light for a lost soul?

Can you share examples using hypothetical incomes and comparing one who pays those taxes upfront and invest in same retirement funds versus one who does a 401K but add extra expenditures to forming one?

I spoke to my CPA but seem to be on a similar page at this time.

I’ll try to keep it simple:

Let’s say you can contribute $50,000 and you HAVE to put away $10,000 for your staff AND annual administration costs are $3,000. Let’s also assume you’re currently in one of the highest federal tax brackets, and between federal and state taxes your current tax bracket is 40%. That $63,000 deduction saves $25,000 in taxes. So $38,000 came out of one pocket and $50,000 went into the other pocket. You're ahead by $12,000. Now let’s also assume the $50,000 doubles to $100,000 by the time you retire. Instead of paying 40% on those earnings over that period of time you've deferred the tax on those earnings until you retire.

So now you retire and what's the "average" tax rate you think you'll pay on the initial $50,000? I'm betting the "average" tax rate will be 20%.; that's $10,000 in tax upon withdrawal and when you contributed it you saved $20k (40% of tax). Don't forget the additional earnings on the $50,000 over the years would have been taxed at 40% and now it's being taxed at 20%, so you saved $10,000 on those earnings, and a total of $20,000.

So the initial $50,000 COST you $13,000 pre-tax (staff and admin), $8,000 after tax, and over the years you saved $20,000 in total taxes. So you come out ahead by $12,000.

Thanks Tim, I knew I could count on you for clarification.

The E.J. consultant did mention LIRPs in our meeting. He mentioned that variable life might be an additional avenue worth doing when you max out your qualify plans.

Now what about adding a define benefit plan versus a LIRP? E.J. consultant mentioned you can sock away a ton more into retirement adding a define benefit when you get to that point. However when is it to that point?

It seems if you add a profit sharing component to your 401K, you are definitely shelling out some money. Likewise having a define benefit plan.

I guess when is it the best time to do a 401K vs. other retirement vehicles and at what income level should you consider these plans to maximized retirement and tax savings upfront and in the long run ? A loaded question, but I'm sure I'm not the only person in the same boat with the same questions.

Your continued questions require personal and specific analysis and suggestions. You seem to be getting this from EJ and at some point you have to select a financial advisor you trust and take their advice.

With LIRP, it's just another name for socking a ton of money into a life insurance product with after tax dollars; therefore, those dollars better come back tax-free. Certainly the earnings MAY come out tax free; however, your investments better do pretty well to pay the high costs associated with a life insurance product.

Generally I believe life insurance products used as additional savings vehicles only make sense in certain situations. They're not for everyone; however, they can work well in certain situations.

Doesn't this imply there won't be any major changes in the tax code? Don’t know how safe an assumption will be anymore.

Ok. What changes should one assume?

To NOT make assumptions on specific changes doesn't really imply anything, other than to imply that I won't assume what changes MIGHT happen.

I suspect in 20 years the marginal tax rates will be higher across the board. I'd rather pay the tax on it now when I know what the rate will be and not chance it to the future. Didn’t capital gains tax go up quite a bit recently? You have to pay for these social programs somehow, eh?

My CPA said the same thing. This year tax he predicts rates for the top brackets, as well as capital gains taxes will be going up 3-5%. Who could have ever imagined that immense social programs would cost money?

I agree, there will be increases in the tax BRACKETS, but also note the other key word MARGINAL.

As of today I don't have to predict that the tax rates are going up. As of today, the Bush tax cuts are going to expire at the end of 2010 so we KNOW the tax rates are going up AND we know EXACTLY what those rates will be. Now congress might change that.

Long term capital gains are going from 15% to 20%; however, I don't believe that's part of the equation if comparing retirement plans vs. LIRP's. It certainly does if you're going to compare to basic after tax investments.

I’ve mentioned this before so here it goes again. There’s a HUGE difference between your MARGINAL tax brackets TODAY vs. what your AVERAGE tax RATE will be when you retire (that's assuming we retain our progressive tax system).

Think about it, all those that are converting to ROTHS in 2010 might be doing so at their TOP brackets of 33 or 35% not including STATE tax rates. If you DON'T convert and you take the taxable withdrawals when you retire, you'll take that income through all the LOWER tax brackets first and you MIGHT hit a higher MARGINAL tax BRACKET of 40% or 45%. HOWEVER, the AVERAGE tax rate you're likely to pay is more like 20%-25% (federal) AND many states allow an exclusion of pension income for state income tax purposes. For employer qualified retirement plans, don't forget the payroll taxes you'll save on PS contributions AND pension withdrawals aren't subject to payroll taxes either.

So I believe MANY people are going to pay 40%+ upon their ROTH conversions in 2010 when they could potentially pay 25%-30% when they retire. That’s just my opinion based upon my clients who HAVE retired and are able to stay below the 30% MARGINAL brackets and therefore, pay an AVERAGE tax rate of around +-20% (federal).

This theory applies to any deductible retirement plan. If you can save 30%-35% today and have it taxed at 20%-25% in the future, then you're ahead of the game. The question is how do these savings (or potential savings) compare to the costs associated with these plans? In many cases you can create a retirement plan that helps minimize the staff contributions, not every time, just many times.

Can you elaborate on this Tim?

Sure. There are different types of retirement plans: IRA based plans, defined contribution plans, defined benefit plans and cash balance plans. Within these plans, a pension administrator can usually write the plan to achieve the owner’s goals, as long as the plan passes certain non-discrimination tests.

For example, with a 401k/profit sharing plan, it can be age weighted, integrated with social security, a "non-comparability" plan, paired with a cash balance plan, safe harbored, etc.
The employee census information will have an impact on how much can be done. I was at a seminar yesterday and they gave an example of a typical dental office, owner between 45-50, average age of staff was around 25-30 and with the basic profit sharing plan only the employees were getting 30% of the pot. Add a 401k and it dropped to 20%. Safe harbor it and it dropped to 15%. Add a cash balance plan and it dropped to below 10%.

Will this happen every time? Absolutely not. You have to look at the census info, the earnings of everyone, hire dates, ages, hours worked, turnover experience, etc. A seasoned pension administrative person for a firm will know what to look at and they'll look outside the box to try and create something that works the best and passes the test.

The brokerage houses that offer pension administrative services will usually offer the straight and narrow plans. Their pension folks are simply hired to do the annual administration, NOT to look outside the box for each and every brokerage client. THEY won't come to you with ideas whereas a seasoned pension firms will evaluate the employee census data each year and come to you when they see changes that MIGHT warrant improvements to the plan.

GOSH TIM! This is overwhelming information, at least for me to digest in one pass. Again, I'm kind of fresh on a retirement plan. Only thing I've got are Roth and Traditional IRAs.

It’s a lot of variables to consider. Then again we are all dentists, and the numbers for overhead and production are fairly consistent across the boards compared to dealing with a broad customer base.

Does your firm offer something to this nature…

No, we're not pension administrators and I know just about enough to be dangerous.

…or can you possibly suggest any seasoned pension folks you are talking about. I'm in the market for folks that deliver on time and with good customer service.

I've had very good success with this national firm: http://www.benetechinc.com/

You can also do a search in your area for a local company or ask around to the doctors that have been open for 10+ years to see who they might use.

My wife is a solo practice lawyer with no employees. Is it wiser for her to start her own, or can I incorporate her into the office 401K? We have put most of our money in real estate, but I'm ready to go past my max in the 401K and our two IRAs each year. My accountant told me I had to consider a pension plan for 2011 or get killed by the IRS.

Look into a solo 401K or single 401K. I know Oppenheimer has them and this might be perfect for her. If you can fund upwards of $100k+ depending on her age you can ask about pairing it with a DB plan or a cash balance plan.

I would NOT throw her onto yours if she can do her own.

100k!!! Holy crap... that's the ticket!

Yep. I have an Ortho IC client: works in several GP and Pedo practices as an IC, no employees, with a paired DB\PS\401k plan. He's averaged around $175k in contributions over the past couple of years. You have to be able to afford that level of contribution though. I wasn't aware you could have a DB and PS plan until benetech suggested it.

This first appeared on Dentaltown.

Send your questions to Tim Lott, CPA, CVA at tlott@dentalcpas.com

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Tuesday, June 1, 2010

Conventional Loan or Other for Dental Practice Financing?

Ok. So this is for my wife. She is looking at a couple of loans to do a buyout of a practice. We could do a conventional loan at roughly 8.25 percent or there is a variable one at 5.5 percent. We were also offered a loan which is locked for 6.1 percent for 5 years or 6.5percent for 7 years and renewed then.

First question is: do you think interest rates will increase 3 percentage points in the next 7 years?

Which one would you go with? I honestly don’t know too much of the details. I think the 5.5% is a SBA loan and the other is a loan 6.1 or 6.5 that is privately financed for professionals. The 8.25 percent is across the board with conventional loans.

This is for an ortho practice and price is roughly 900k

It depends on the specific situation and your ability to pay off in five or seven years. I prefer fixed rates for longer terms (10-15 years), and variable is fine for shorter terms (2-3 years). A 5-7 year term is a toss-up.

If the practice is priced right, you should be able to pay it off in 5-7 years. Therefore, I'd review my cash flow analysis for the 5-7 year fixed rate loans and see if it works, and if it does, go with either of them as my first choice.

I assume the 8.25% is a 10-year term and the 5.5% variable is tough to overlook even though it is variable. Yes, I think the variable rate could climb by 3 points in 7 years; however, the interest savings you'll achieve over those 7 years will likely more than offset any interest cost at a higher rate in the last 3 years. Remember: the rate may be higher than 8.25 in 7 years; however, the balance is MUCH smaller.

I've gone through this once before with my practice. The loan term is for 10 years on the 6 percent ones. It'll be paid by then, hopefully sooner. We are going to shoot for 7 years. I’m just wondering if interest rates will jump 3 percent in the next 5 years. That's the big question for us. We are trying to figure out if we should get the fixed rate of 6.5 for 7 years or 6.1 for 5 years If we refinance after the 5 or 7 years on a 10 year note will interest rates be high enough that we did not benefit from the lower interest rates. The 5.5 is at a variable from day one. This one can be scary. I don’t know too much about interest rates but I know they will need to go higher in the future to offset inflation. I was hoping to get some help with this.


This first appeared on Dentaltown.

Send your questions to Tim Lott, CPA, CVA at tlott@dentalcpas.com

For more information or to sign up for our newsletter, please contact arose@dentalcpas.com
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