NOVEMBER 9, 2022 (26-MINUTE READ)

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Ileana Cruz:

Sometimes dentists, they lose sight of the big picture. As dentistry continues to evolve, they have to understand what tools that they need to incorporate into their practice that'll make them work smarter, not harder.

Corey Brown:

I'm Corey Brown and this is Provide's The Path to Owning It podcast, where I sit down with trusted industry experts in Provide's network to give you the tools and advice you need to take your practice ownership dreams into your own hands. From owning your own practice to expanding or improving an existing practice, we'll help pave the way for you to achieve your dental or veterinary career dreams and guide you through all the nuances of the practice ownership journey.

Please make sure to follow us on Apple Podcasts, Spotify, or wherever else you listen. On this week's show, we're discussing what you need to know before making an investment in new equipment for your dental practice. We are joined by Ileana Cruz, Territory Manager for Patterson Dental, currently. Covering the South Florida region, Ileana has been in the dental equipment business for over 24 years and oversees many different areas including technology, software, supplies, and services. Her goal is to become a partner alongside her clients' practices to maximize their systems and continually add value as dentistry continues to evolve. Ileana, thank you so much for being on the show today. We're very happy to have you.

Ileana Cruz:

You're welcome, Corey. Thank you for having me.

Corey Brown:

Absolutely. When it comes to making the decision to invest in dental equipment and technology, I'm sure there's a lot to consider. So let's just jump right in. What do you tell your clients when they're on the fence about making this investment?

Ileana Cruz:

Sometimes dentists, I always talk about this, they're in a micro environment. They're always looking to restore a single tooth at a time. They lose sight of the big picture. As dentistry continues to evolve, they have to understand what tools that they need to incorporate into their practice that'll make them work smarter, not harder. And also, because of social media and because of all the information that we have on the internet, the patients that are coming into their practices are a lot more educated on what they're looking for. For example, if you have a millennial walking into a dental office and they need to have a crown done, they're not going to want to a lab to do that. They're not going to want to come back for that second and third visit. So they're going to be looking for someone that could get them in and out of there in a single visit appointment.

Also, I think today people have cone beams in their practices. And the reason they have cone beams is because now that's the standard of care. So there are people that are asymptomatic. They may have a broken root that's never given them an issue. But when they don't have this technology, then they're not treatment planning the patient comprehensively. These are the things that patients, some of them know, some of them don't know. But they're looking for these things. They're looking for the look of the practice. Are they having the greatest and latest technology? Are they having an old chair that looks like it was around 30 years ago? People are very visual. And in the way that they're spoken to, it's almost like dentists today need to create an experience to be able to bring that value proposition and educational point to their patient.

Corey Brown:

Yeah, absolutely. And things like same-day crowns, that's a great example of some efficiencies that new equipment can provide. What other efficiencies or other examples does new equipment provide a doctor with?

Ileana Cruz:

We have even lasers now that actually cut and prep teeth. So you can actually take anesthesia out of the equation. It also gives the dentist the opportunity to be able to become more productive. Instead of doing quadrant dentistry, they can do full mouth dentistry. So if you're doing soft tissue, crown lengthening, if there's anything else that they need to do, they can go ahead and do that because they're not doing anesthesia.

So these are also technologies that are there that's more in the restorative end. But also, soft tissue management and things like that that they can help them with, that's another favorite one of mine that goes right alongside with single visit or CAD/CAM dentistry, where you're actually fabricating their restorations in house. They go hand in hand because it makes it a lot easier. Plus, it stops bleeding if you're doing crowns and you're actually doing subgingival crowns. Now I'm going to go into some clinical terms. But obviously, there's bleeding and things like that, and these things make it a lot easier for the patients to heal. There's many uses. They're even using it now in the snoring and sleep areas where that's a whole different topic of what this technology can give.

And the CBCT, the cone beam, can give them access to the airway. My mother, for example, she's 84, and I was the one that diagnosed her with sleep apnea because she was getting tired, she was falling asleep. It wasn't through dentistry that it was diagnosed. It was through the general doctor that I took her to and I said, "I'd like to have a sleep study done." That should have been something that should have been owned by the dentist. I think that they need to own the airway.

So I think it's exciting to have all these tools in your toolbox. And there's other materials and things like that that are coming out there that make it easier so that you're touching the tooth less, being more proactive, and actually meshing together the medical side of this and how it impacts the patient, because health starts where? In the mouth. If the mouth is not healthy, it goes down into your heart, it goes down into your digestive system, et cetera.

Corey Brown:

Absolutely. And you get those systemic issues from that. So besides saving time for patients, how does having that state-of-the-art equipment kind of help attract patients to your office?

Ileana Cruz:

It's a type of patient that's walking into your practice. When they see what you're doing and how comprehensive and the tools that you're using, that is something that they go and talk about. I still firmly believe, even today, I have some doctors that are amazing. They actually pay influencers to follow them, and they're constantly recording and they're generating a lot of new patients into their practice. And that's the name of the game of how things are changing.

But I still believe in the word of mouth. I still believe that if you do bring in a patient, if you educate them, if you show them what you have, they go back and they say, "I just went to that practice." I actually have vendor reps that I'll send into an office and they say, "I knew this is your office." For me, on the sales cycle of it, I have to be able to sell something that works.

And then when something new comes out, I take my time. For example, 16 years ago or so, when I started to really dive myself into CEREC, for example, I had a couple of PFM crowns in my mouth that I had done in college that probably shouldn't even have been there, but they were there. And of course, I took my dentist. She's one of these people that always says, "Are you sure we should do this?" Yeah, I'm sure we should do it. So I actually had her remove those crowns, redo them. I studied the clinical aspect of it, What are the pluses behind it? Then I took it apart and I looked at the costs behind it.

What's really cool about all this technology and their affordability, it adds more procedures to their chair time. So if I have a patient that I can come in, I could treat them completely, and send them home, it's not only the time for the patient, but the time for the doctor just became more productive. So if you didn't have CAD/CAM dentistry and you wanted to do a three or four surface composite, they have to still spend an hour preparing that tooth, the anesthesia, building it up. And then I'm going to tell you that in five years, regardless of how good that restorative material is, they will have to touch that tooth again, because eventually it'll shrink.

When you have that technology, I could go in there and say, "You know what? I'm going to do an onlay." I put something in the patient's mouth I'm not going to have to touch again, and I gave them something that will be the best course of action clinically. Obviously, this is up to the doctor's clinical choice, but these are the options that technology gives you. It gives you the opportunity also that if you have someone in the hygiene room and you have an open spot in your chair, somebody can come in with a broken cusp in hygiene and say, "Oh, we can put you right into the doctor's chair instant." Otherwise, you would have to schedule that patient out. You would have to temporarily fix that tooth, then schedule them so that you can go back and do it, because you're doing it the analog way, which is the lab way.

So I think obviously we're starting to see a trend that years ago, when I did my first digital integration for X-rays, for example, a lot of reps were saying, "Oh, we're going to lose the business on the film side," et cetera, this, that, and the other. But when people went digital, they saw the instant radiograph. They were able to educate their patient. They were able to show what they saw on that radiograph immediately. They were able to diagnose better.

Corey Brown:

You did mention trends with dental equipment and technology. Can you tell us what those trends that you're seeing today are and what the next couple years in dentistry might look like?

Ileana Cruz:

I think we went from an early adopting stage to some of this technology to that now, for example, all offices that open new are going straight into cone beam. Now, cone beam is covering the airway. There's actually endo features. Now, you're advancing some of the programs for implant crown down planning of restorations, also restoring implants, the better placement of implants. It's a surgical situation they use to find bone versus the restoration that was wasn't an ideal situation for a restorative dentist to have, because then they get this implant in there and they're thinking, "How am I going to restore this?"

So the communication is getting better between that because of these technologies. It continues to trend and the communication factor of bettering the outcome for the patient and giving the necessary tools to the doctor to be able to better manage the patient, better educate them, and actually be more profitable as well, because now they're actually getting more control of their treatments by adhering and incorporating these technologies.

It takes time for people to change. And let's face it, change is not good for a lot of people. They don't like it. But I think that laser technology is at the early front. They have maybe 900 lasers out there right now. Definitely CAD/CAM or digital dentistry when it comes to impressioning is definitely gone through the roof. There's still a lot of people that don't want to dabble into the milling cycle of this, so they just want to do digital impressions. But at least that's cleaned up the communication between the lab and the dentist and it's made the dentist better aware of the restorations.

But as far as things that are coming up the pike, we're getting into that aspect of it of laser dentistry for restorations. I think that's going to be more of a hotspot. They do everything through software. So they have analytics on what the doctor's doing, which is incredible. And it'll tell you what percentage of the practice is even using anesthesia anymore. So it gives us back a lot more data so that we understand what procedures are better for what and things like that from a technology standpoint.

There's also other stuff on there like buffering anesthesia for people that want the anesthesia route. I see things becoming very digital. Even the way that you store your information and how you communicate with the other doctors is going to be... It already is on a portal, like DS Core that they have everything there. You can have your 3D printing. That's the other one that's actually beginning to just boom, people having the capacity to do their surgical guides, being able to do their splints, being able to do their mouth guards. There's doctors out there now that are actually doing digital dentures, and they're phenomenal. The materials that are coming out are far better anything that could be fabricated in a regular lab, stronger and more aesthetic.

So it's just amazing what we could do in a 3D world. Really, it's what it is. It's going down that path of having everything three dimensional and it's creating the systems around these practices to have these toys. I have plenty of practices that have them. Some of them, they have them and they use them to a certain capacity, but that's like software. For example, Eaglesoft, our software probably gets utilized 50% of the things that we offer on it. So it's people getting more focused, hone in on the technologies that they do have.

Now, I'm starting to see after COVID, because of all the Zoom calls and all the people had to actually realign themselves of what they're doing, I'm actually seeing a lot of doctors reinvest in their continuing education and actually putting forward what I'm talking about, which is putting all these tools to work together for them.

Corey Brown:

So that brings me to my next question. With COVID-19 that you mentioned, how has that impacted your industry? Has it affected the design of equipment or how doctors use it?

Ileana Cruz:

What we've definitely had is supply chain disruption. The cost of the equipment has changed because of those factors, has really impacted the industry. But on the flip side of all of this, a doctor that's educated through Section 179, they have money that a lot of times doctors, because they don't have the right accountant to their side, they end up paying money to Uncle Sam that they could have taken and reinvested back in the practice for technology, for example.

But I think the biggest disruptor, aside from that factor, we did see a lot of companies that were disrupted in their representation. Some reps were let go that were good quality people. Our doctors in our business is parallel. We lost good people. They lost good people. We're still struggling to find those good people, because it changed the landscape of people in general and the quality of employees that you could find. I think that impacted a lot of practices.

But then doctors kind of reevaluated what they were doing. And I've had practices that have gone to assisted hygiene, for example, because they haven't been able to find that second hygienist that they had. So they've made the head hygienist more profitable.

I'm starting to see that companies that were shaken a little bit are reorganizing again and refocusing on what needs to happen and where they need to head. And again, it goes back to, "We're here. We're going to continue to be here. This is a recession proof business. It has been historically."

One big lesson to be learned was the fact that we were not considered essential and they were only allowed to do emergency cases when, at the very forefront of all of this, dentists have always been dealing with people's DNAs and they've been dealing with however many viruses and things like that. Some of them, they look like they work on the moon when they outfit themselves. But the statistics are there from the ADA that they've always been on their A game when it comes to be able to managing any type of diseases or anything like that that are airborne.

I have to say that that's the biggest disruptor that has done that. But as far as interrupting the future of where it goes, they had to learn to become smarter with their time. They've realized that if they're driving and they're letting go of a certain percentage of certain insurances, if I was in your shoes, what I would do when my skillset becomes better and I have the necessary tools around me to become more efficient is go out of network, become fee for service, provide that experience. And the only way that you could provide that experience by surrounding yourself with those technologies that we've been talking about to make them more profitable and more on point, so that they can go in there. And instead of seeing those eight patients, maybe they do four patients and do the same and do it more organized and have more profitability.

Corey Brown:

So with all the advantages with time efficiency, profitability, patients enjoying that sort of experience, why are there still doctors out there that are hesitant to upgrade their technology?

Ileana Cruz:

Mindset is a big deal. It's a big deal for all of us if you think about it. If I'm not open to change, I'm going to continue to do the same thing over and over again. And that's where we're seeing some doctors that are frustrated.

So what I personally do for a lot of my clients, whoever chooses to want to have this service done, is I do yearly checkups. And there's other systems out there like Dental Intel and things like that that show them on a ticker every day of where they're headed and where they're faltering. So it's not reactive. It's proactive. But it's just being aware of where you're navigating and where you're headed.

And then maybe the vision you had last year because of a change in staff or a change in your personal space might have to be realigned. But then it's that communication with a team. It's that education component. And the hesitancy has always been, "What if I fail?" The biggest objection that I ever received in CAD/CAM was that, "I don't want to change the way I do my schedule. I don't want to have to see that patient. What if they can't pay for the crown in one visit and I have to stagger it to three visits?" And I'm like, "Well, you're the one that's losing in that proposition, not the patient." And let's face it, they're a consumer. If they want to go to that concert or if they want to go to that cruise ship, they're going to have to pay for the ticket before they get there. It's no different. I'm like, "Why are you devaluing yourself with the insurance proposition? Why are you devaluing yourself with all these things?"

It goes back to that mindset. If the people that are willing to not make those changes, unfortunately they're having to make changes that may not be the best thing for them based on the lack of want and need of them wanting to get out of their own comfort zone. I'll use one example of one doctor that she fought me on going with CEREC for a long time, and she told me time after time that her professor told her it was just not a good technology.So I finally got her to a point where I said, "I think you should look into it again." And I said, "I'm going to tell you this disclaimer." I said this, "When you do do this, you're going to tell me two things, "Why didn't I do it sooner?," and, "I became a better dentist." And she didn't say anything to me. She went and looked at that technology. She actually not only bought CAD/CAM, but she actually bought 3D cone beam at the same time. And it was right before COVID.

And I did get the call. When she did adapt and she did make the change, she called me and she said, "You were right." And I wasn't doing it for that reason. I just get a kick out of it. But it's different for everybody. And sometimes, especially now, they have a lot of communities that they have a question, they go on a group chat. They feel the pulse from some other people. Sometimes it's good, sometimes it's bad. But it does nudge them a little bit. Some of the influencers out there nudges people to do and make the changes as well.

Corey Brown:

Yeah. It's fantastic advice. Thank you for sharing. We've talked a lot about the benefits of upgrading dental equipment and what's trending. Next, I'd like to explore when to buy, and you hinted at it earlier and what advantages might be available before year's end. So more with Ileana Cruz after this short break.

I'm Corey Brown, and this is Provides: The Path to Owning It podcast. We're back with Ileana Cruz with Patterson Dental to talk more about dental equipment and when the best time to purchase is and why. Ileana, I've heard of tax benefits that are available to those looking to purchase new dental equipment. Can you tell me a little bit more about that and what that looks like?

Ileana Cruz:

At the end of the year is probably one of the best times to reinvest money back in a practice. It depends on what the doctor's tax brackets are. But there's always a section 179, and I usually start asking offices around the time of October because of ordering and things like that. For example, if you're investing in my favorite word CEREC, you're looking at $150,000 investment. But if you have a 35% tax bracket, usually you end up saving about $54,000 in taxes that you can put back towards the investment. So that really brings down the cost.

That's always been a concern of people like, "Oh my god, I have to pay $150,000." Well, what they don't realize is that they pay over two million dollars over the span of their career to a lab to be able to have no control and obviously have less time. So who wouldn't want to do that?

My role of thumb is that if your accountant doesn't have at least a hundred dentists in their book of business, I would seriously consider looking at another option, because you don't realize how much money you'd leave on the side.

I had one client this year that I'm upgrading his cone beam that he did six or seven years ago, and we upgraded the office to electric motors. So he did that because last year he got killed. They did so well last year, which a lot of practices, because they were down from COVID, they came back and they... Last year, for the most part, everybody did. It was a tremendous year. But they got hit with taxes big time because some of them had to pay taxes here and there.

And preemptively, those are the conversations that they need to ask their tax advisor. Again, having the right tax advisor to surround themselves with is key. But again, that's money that they can take and say, "Maybe I didn't do that extra room, or maybe that integration didn't happen, or maybe I wanted to get that 3D printer, or maybe I wanted to bring in a Solea and bring in a laser."

So those are the questions that they have to ask yourself and just make sure that they have that tax advisor that's qualified to give them that information. If not, obviously reach out to their company that they do business. We have the tools and the arms to be able to help them to understand that better.

Corey Brown:

That's great advice. Is there a timeline that one needs to meet to qualify for this tax advantage? Does it have to be done before the end of the year?

Ileana Cruz:

Yes. December 31st.

Corey Brown:

Okay.

Ileana Cruz:

It needs to be installed and it needs to be invoiced, because usually people wait. This year is different because of the disruption. We have some things that are not here. I have X-rays that are on back order. They've been on back order for two months. So we have to play around with stuff like that. Chairs, depending on the manufacturer, there's chairs that are out four months, chairs that are here.

I've had people call me Christmas on vacation, "I need to spend $25,000." And I'm already on break too and I'm like, "Why are you doing this to me? I don't want to do this right now." But that's what I'm saying, because they find out at the last minute. So now is the conversation to be had. What do you need to spend and where do you need to spend it? And even someone that has a bunch of technology, which I have clients like that, there's always opportunities to reinvest back in the practice. It's better to do it there, where it's going to give you back some return, than to pay it out in taxes. But yes, December 31st, installed, invoiced.

Corey Brown:

Is there still time where we are, November 9th when this airs, to get that installed and invoiced?

Ileana Cruz:

Absolutely. Absolutely. But obviously, the quicker that you communicate your needs and the areas that you want to look at, there's always... Every dealer has a ton of different product lines that they carry. But yeah, the sooner, the better. But it can be done. It depends on your relationship of the install teams and things like that. But if it's just cone beams and CERECs and things like that, those are easily things to be able to do. And the same thing with Solea. Those are easily things to install, and you could get them in there before the end of the year.

Corey Brown:

And then what type of equipment qualifies? Is this everything, technology, software? Where are the lines?

Ileana Cruz:

The equipment would be capital equipment, like chairs, units, CBCTs. I don't think software qualifies for it, but I would have to need to check on that. But anything else that has to do with hand pieces, electric systems, things like that, that would be part of equipment, chairs, units, lights, compressors, vacuums. Any equipment would qualify for this.

Corey Brown:

And then how would they go about filing this benefit? Is that through their equipment dealer or that be with their CPA that you had mentioned earlier?

Ileana Cruz:

We would install it and invoice it, obviously, but then they have to follow up so that they make sure that when they do the depreciation schedule, that section 179, they take that depreciation during that year so that it helps them with their tax liability.

Corey Brown:

And if a provider would like to work with you to help them outfit their office with this new dental equipment, how would they reach you?

Ileana Cruz:

Patterson obviously has branches in every state. For example, here in Florida, we have three branches. We have one in Fort Lauderdale, one in Tampa, one in Orlando. I would reach out to the respective branch of the area and reach out to the branch manager and ask for the representation if they don't have it. If you're in the South Florida area, you know where to find me. I cover anywhere between West Palm and Miami. At Patterson, we actually have a CAD/CAM specialist and we also have an equipment specialist and myself. I always say I'm the head of the octopus.

So obviously, we all work together as a team to make sure that the doctors are taken care of. But that's probably the best way. And if you have my contact and somebody needs to reach out to me for me to help them get better placed within the organization, I'll be more than happy to do that anywhere.

Corey Brown:

Fantastic. Well, Ileana, thank you so much for sharing your expertise in dental equipment technology with our listeners. We appreciate your time and would love to invite you back to the show anytime.

Ileana Cruz:

Thank you, Corey. I appreciate your time as well.

Corey Brown:

Thank you for joining us for this episode of The Path to Owning It. If you are ready to take your practice ownership dreams into your own hands, be sure to visit GetProvide.com to pre-qualify and browse our practice marketplace, or check out our news page for more helpful resources. The Path to Owning It is brought to you by the team at Provide with production assistance from Sarah Parkey, Cody Changit, and Liv Cannaughton. And it's produced by Podcamp Media, branded podcast production For businesses, PodcampMedia.com. Producer Dusty Weiss, editor Larry Kilgore III.

For Provide, I'm Corey Brown. Thanks for being on the journey with us.

 



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