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With news headlines sounding alarms like, “Joblessness on the Rise,” “Mortgage Crisis Unfolds,” “Record-Breaking Oil Prices,” and “Recession Looms,” one could easily assume that the U.S. economy is in for a dramatic downward spiral. Just as with other stories in the news, however, reality is much more subtle than the headlines. Although the short-term outlook for much of the economy is bleak, not every sector will suffer. “Even though we’ve seen some dramatic economic shifts – particularly in the real estate market – RV resorts and manufactured home communities continue to be sound investments,” says Leon D. Meekcoms, President of Parkbridge Capital Group, Inc. (www.parkbridgecapital.com), a privately held real estate investment, acquisition, and brokerage firm.

Meekcoms attributes the strength of the manufactured home and RV resort markets to two underlying factors: prosperous Baby Boomers on the verge of retiring are trending toward having affordable second residences, while vacationers are opting for seasonal recreation within driving distance of their homes. “Properties within two hours of major cities and those that are in the Sun Belt will continue to appreciate and provide the foundation for increasing returns over time,” says Meekcoms.

Pre-built resort cottages, commonly referred to as “park models,” are perfect for cost-conscious Boomers. Maxing out at around 400 square feet, these mini-homes may look like cottages or cabins, but are legally RVs. “Park models are the ultimate hybrid,” says Meekcoms. “They can be luxurious and have myriad amenities like a house, but without the tax implications of a permanent residence.” Because of the dramatic increase in the popularity of park homes, manufacturers are enjoying keeping up with consumer demand.

Similarly, traditional RV manufacturers are seeing strong demand, and industry insiders estimate that over 8 million families will own recreational vehicles by 2010. Although one might assume that record-breaking fuel prices would discourage RV travel, Meekcoms says that the opposite is true. “Research indicates that those who own RVs overwhelmingly feel that RV vacations are much less expensive than other travel options,” he says. “What we’re seeing is that RV owners are spending less time on the road and more time at their destinations.”

Trends in both park models and RV travel are strong indicators that RV resort properties are a wise investment, which is why Parkbridge Capital has focused on this market. “The number of upscale park model and RV resort communities is relatively small, so demand is sure to outstrip supply in coming years,” says Meekcoms. “We’re confident that buying, upgrading, and expanding existing properties will maximize investor return while providing Americans with an affordable, or even quite luxurious way to achieve the lifestyle that they desire.”

(This is Part One of a two part article on the subject of Dental Associates.)

Several times a week I field associate related questions from colleagues. These come from dentists who need one right away, as well as those just entertaining the idea for the future. The pros to adding an associate are obvious: more service for your patients, potentially more time off, someone to cover emergencies, etc. There are also plenty of cons: your patients may not like the new doctor, and you might worry about them making off with your patient base, etc. When discussing associates, thirteen years in private practice and close to as many as a trainer/consultant have taught me one hardbound rule: there is definitely a right and wrong way to go about this associate business.

If one or more associates are in your future plans (whether this is now or ten years from now), there are several things to consider:

1. When should you get an associate?
2. How would you structure compensation?
3. What’s the best way to find one?
4. What are the important points to cover when interviewing?
5. How will you integrate them into your practice?

I’ll start with number one: When should you get an associate?

Arguably, this is the most important question. This is also where I see the most errors made. Let’s say you are doing moderately well, still have some openings in your schedule and get about 10 new patients per month. You decide to expand your hours and bring in an associate to become more productive. The reasoning seems sound – you are adding more hours and providing more treatment opportunities for your patients – but this rarely works. New patients don’t magically show up, the associate is unproductive and unhappy. You either a) let him or her move on or b) start moving work from your schedule to make the associate busier/happier. The net result is less profit and a problem, i.e “how do I keep my associate busy?”

In this scenario the office was in no position to justify adding an associate. As such, this begs the question: How do I know when the “right time” is? To answer this question, ask yourself the following:
a) Is your practice growing (or has it grown up to now and you just seem to have “maxxed out”)?
b) Are you scheduled efficiently?
c) Is your business profitable?
d) Is your schedule relatively full?

If you answered “Yes” to all of the above, now is probably a good time to add an associate.

I’ll give you this scenario: Your practice has rapidly (or steadily) expanded up to a point where you can’t take in more patients than you currently are. You are operating efficiently and the office is profitable. You just can’t see more people and things start to book out a couple of weeks in advance. Now is the time to add that associate to serve three purposes:

1) To provide faster and more efficient service to your patients,
2) To lighten your schedule so you can focus on the type of work you want to do and
3) To increase practice productivity.

If my practice was in the above situation, I would look at adding an associate – perhaps one to two days a week to start and roll from there.

From a practical standpoint, I would also look at how many charts I had. In my experience 1,000 charts, if handled efficiently, can potentially keep a doctor and hygienist productive. Also, maintaining a ratio of one doctor to one hygienist seems to work best. If you are already have two full time hygienists (who are booked), chances are you need an associate now. However, you also need to consider the other points above.

Business survival is inexorably connected to expansion. If the office is well-run (which would mean that it was expanding at least a little bit), there would come a time when you couldn’t produce any more yourself and would need an associate. The level of production that will require an associate will be based on your style of practice, fees, type of dentistry you do, etc.

At MGE (http://www.mgeonline.com) we suggest you get an associate when there is more work than you personally can handle and patients are being pushed out on the schedule too far.. How long is too long for them to wait? Although this is ultimately your decision, it shouldn’t be more than a couple of weeks. Too long of a wait is just not good service!
One of the questions asked above when deciding whether or not you should add an associate, asked about expansion. How much expansion do you need? To start, are you even getting enough new patients to support yourself? How many should you be getting? This depends in a large part on how you practice, but I’ll give you a basic formula to use:

a. Take your total number of active charts
b. Multiply this by 20%
c. Divide “b” by 12 (months in a year)
d. The figure from “c” above gives you the minimum number of new patients you should be getting on a monthly basis to maintain your practice’s health. Note that this is just to keep you going. You would definitely need to exceed this number to add an associate.

Example: Dr. Smith has 1200 active charts. 20% of this is 240. 240 divided by 12 is 20. To maintain a healthy practice, Dr. Smith should be getting at least 20 new patients each month.

Keep in mind this formula assumes a couple of conditions exist:
a) The new patients are fee-for-service.
b) The doctor has an acceptable skill level when it comes to treatment presentation and acceptance (which is reflected in production and collections).

If you want an associate, I would recommend that you far exceed this 20% factor. This is where the “MGE New Patient Workshop” comes in handy – whether you want an associate or not. If you want more fee-for-service new patients to keep your practice healthy, to expand or to make it possible to add an associate the “New Patient Workshop” is the solution.

About Greg Winteregg DDS:
Greg Winteregg, D.D.S is a graduate of the Indiana University School of Dentistry and was an MGE (http://www.mgeonline.com) client for 18 months prior to becoming a partner in the company in 1994. While a client of MGE he increased the number of new patients from 10 per month to over 60 per month – with no HMOs, PPOs or discount plans! During this period, he was also able to successfully integrate an associate and more than double practice revenues, while and reducing his work week to under 25 hours.