As a small business
owner, a dentist has many responsibilities to keep the business running
smoothly; employing staff, maintaining the office equipment, marketing
for patient flow to name a few. However, with all the careful planning
and attention to detail, there is one aspect that the majority of dentists
don't plan for, which is how to keep the business viable if the dentist
is unable to practice. Every year a fellow practitioner may unexpectedly
lose the ability to practice due to an unexpected injury or illness.
Weeks or months of lost practice time will affect patients, staff and
cash flow. Moreover, disability insurance has a waiting period before
benefits will be paid, typically three months. In this article, I wish
to share events that I have witnessed and ways in which they were handled
in hopes that others may benefit through proper planning and organization.
Since 1983 when I first became involved in dentistry, I have worked
in nine major metropolitan cities and served clients in countless others.
During that time, numerous events occurred that were both sad and frustrating.
Dental offices were left stranded without a practitioner for a variety
of reasons including: a dentist needing time off for recuperation after
emergency surgery, dentists with broken arms or hands, and unexpected
In these cases, the dentist wasn't able to treat patients, the employees
in place didn't know what to do, and the spouse often did not have the
business acumen to carry forth the business operations and therefore
the business faltered. In the event of death, a practice's productivity
would plummet until a potential buyer arrived with an offer far less
than the previously thriving business was worth. Sad, but true, the
estate of the deceased dentist may be left with little if any proceeds
from the sale of an asset.
Most dentists carry disability insurance, but again the period of time
until benefits begin may be far too long to wait for much needed funds.
This can destroy a fine dental practice. An option to managing operating
expenses when little income is being generated is to carry office overhead
insurance. This policy protects the short-term financial needs of a
practice with payments until the disabled dentist returns to work.
But even overhead insurance has limitations; will the proceeds from
insurance enable the office to remain viable, keep the patient base
intact, and continue to employ staff until the dentist is able to work
again or the practice is sold? Most likely the answers to these posed
questions are NO.
Rather than risking harm to a most valuable asset, dentists may consider
becoming involved with a group of conscientious dentists in their community
who would help preserve a practice if something unexpected happened
to one in the group.
I have designed a successful program to help a 'fallen' dentist's practice
remain viable. It is based on a simple premise, that the dental community
is a caring one, willing to volunteer services for fellow comrades.
The program is termed "Inter-Practice Protection", and it
has worked successfully in Arizona since developed in 1997. The concept
is straightforward: form groups of like dentists who agree to volunteer
coverage for each other in times of illness, short-term disability,
trauma, or death. This is not an insurance policy; rather, it is assurance
that a practice, the team of employees, and patients will continue to
be served. Inter-Practice Protection provides coverage for the practice
during a dentist's absence to ensure that it does not lose production,
the team continues to work, and patients continue to receive care.
Since its inception, nearly one hundred dentists in the greater Phoenix
Metropolitan Area have formed six separate groups to cover for their
practices should an untimely and unexpected mishap occur. These groups
are well-structured and organized associations of private practicing
dentists who have committed to volunteering a day of their time if a
colleague within the group is unable to practice.
Members of the group operate their own private practices and collectively
volunteer their time to care for patients and keep the fallen dentist's
office functioning while the doctor rehabilitates, or until the practice
is sold. Patient payments for treatment provided by the covering doctors
are made to the practice being covered.
After activating groups for a variety of reasons, such as cardiac surgery,
a broken arm, a broken hand, and even an untimely fatal heart attack,
the coverage specifics have been fine-tuned, with the participating
dentists input. In addition, the groups' dynamics have become stronger
with each passing year. Following are guidelines for effective operation
of the coverage groups.
· The groups are comprised
of about 17 dentists.
· A Chairperson and Vice-Chairperson
are elected by the group to function as administrators of group communications,
manage annual meetings, and coordinate activation for a doctor needing
coverage when necessary.
· The group provides coverage
if a member is not capable of providing usual dental services due to
non-intentional mishaps, illness, disability, or death. Normal maternity,
without complications, substance abuse, and alcoholism shall not be
considered a disability or illness.
· Upon the event of a disability,
the member or family member promptly contacts the Chairperson to advise
coverage is needed. The Chairperson then calls an activation meeting
to be held at the disabled member's office within 24 hours and creates
a coverage schedule with the members of the group.
· Coverage begins no later
than 15 days after the date of disability, and continues for a maximum
of 12 weeks. Coverage will cease when the disabled member returns to
practice, or upon death when the practice is sold.
· Members covering a practice
are not responsible for managing, administering, or directing the business
of the disabled member's practice. A personal representative, family
member, or other representative of the practice is responsible. Members
may assist without any obligation to do so, but are not liable for any
· The dental team should notify
patients of the disability and make known the name of the covering dentist
prior to the patient's appointment. The team will maintain all normal
business operations, cooperate and assist the member who is providing
coverage, and ensure there are adequate supplies and personnel for the
practice of dentistry.
· Members are not obligated
to cover more than their allotted number of days. After the entire roster
of the group is contacted for coverage, any more additional days of
coverage by a member is voluntary.
· Contact your malpractice
insurance company and ask them specifically: "In the event of my
untimely death, will my policy allow for patients to be treated in my
office by my staff under the supervision of a dentist volunteering his
time and still provide malpractice coverage?"
· Each member must review
their personal information to be sure that the Power of Attorney is
delegated to a significant other so that payments for accounts payable
and payroll may be made without delay.
· If a member is contracted
with an insurance company as a preferred provider, then the member must
find out guidelines for each particular plan in the event another doctor,
who may or may not be contracted with that insurance company in his
or her own practice, treats patients during a covered period. This will
ensure payments for treatment rendered to patients are made to the doctor's
office receiving coverage.
· Members of the group agree
that if a patient of the doctor who is receiving coverage wishes to
pursue care from the volunteering dentist, the volunteering dentist
will decline to accept the patient in his or her practice until a waiting
period has passed. In the event of a disability or illness, one hundred
and eighty (180) days shall pass. In the event of death, ninety (90)
days shall pass.
· Attendance to an annual
or biannual meeting is urged to reunite with fellow members, review
past year's events, and demonstrate commitment to the group.
· Prior to covering at another
practice, a schedule may be faxed so that the covering doctor may review
the patient load and treatment mix. At that time, the covering doctor
may consider bringing some of his or her own instruments.
Through careful planning and preparation, the groups here in Phoenix
were well organized and ready to step in under any circumstances.
On the evening of July 31st, 2003 around 7 p.m., I received a call from
a periodontist who is a member of the "Concerned Periodontists",
an Inter-Practice protection group in Phoenix. He informed me that a
fellow periodontist had passed away suddenly and unexpectedly of a heart
attack at the age of 41 at his home that morning. By 7:30 a.m. the next
day, the coverage group was activated and within a few hours a schedule
was created in which eighteen periodontists had volunteered their time
over the next sixty days to cover the practice.
I arrived at the deceased periodontist's practice at 10:30 a.m. and
was met with an enormous amount of gratitude and appreciation by the
team. To know that the doctor had thought ahead and aligned himself
with a conscientious group of practitioners was such a relief to his
staff, and to know the practice would be covered in this difficult time
lifted a huge weight of concern off their shoulders. In the following
weeks, patients were treated, the staff continued to work, and the business
continued to operate while the surviving estate planned for the practice's
No one really knows what tomorrow brings. We plan for our practices
to grow, we plan to maintain a happy and productive team of employees,
we plan for retirement, and we hope to have enough insurance coverage
to provide financial help in catastrophic situations. Be prepared and
have a plan in place so that your practice will continue to be productive
when you're not there.