What is the first thing that comes to mind when you read "habitude"? Is it a habit, is it attitude or is it something else?

Habit hab·it/ˈhabət/
1. a settled or regular tendency or practice, especially one that is hard to give up.

Definitions from Oxford Languages

Now, start spitting out all of your habits. Think you don't have any? How about-

Created habits are usually kept. Until someone somewhere introduces something done in a new way. Tried anew the first time seems awkward, off-kilter, and possibly uncomfortable. Some master this to success, most give up.

When was the last time you tried something new?

How long did you persevere when you did try that new thing? Did the newness feel strange?

Attitude at·ti·tude/ˈadəˌt(y)o͞od/
1. a settled way of thinking or feeling about someone or something, typically one that is reflected in a person's behavior.

Definitions from Oxford Languages

What constitutes a good attitude? You know those people. They see the glass half full, offer solutions to challenges, they don't get too ruffled when things go south. They lead with empowerment. How do these folks do this? They are usually spotted in a crowd or office environment quickly. Here are some attributes of a great attitude-

How many employers out there wish you had employees with great attitudes, habits, and habitudes? They are out there, you just have to be willing to lead and guide them. At Accelerate My Practice, our coaches unveil many diamonds in the rough and polish up the moderate performers to great habituders. Most times, it is adding leadership and direction to one's plate.

Boundaries and accountability happen next. So often we hear doctors and business owners say they just want to "drill teeth" and not bother with all this other stuff.

Turn your team into a team full of habitude, by shining up those diamonds in the rough.

Dental Dreary Months

The cold, rainy, snowy, ugly dreary dental months happen every year. The days are shorter, the nights are longer and many of us just yearn for this to reverse. We're waiting for that daylight savings day.

How many of you feel like your dental practice lives in these dreary months year-round?

Dentists are highly trained scientists, performing the standard of care of dental medicine to patients using a variety of methods allowing flexibility in the process, however, clinging tightly to a code of morals and ethics. Seems so simple to the outsider looking in, doesn't it? Is this your reality? Or are you the insider looking out? Is there chaos, do you choose tolerance over confrontation, do you long for a well-oiled dental machine in your day to do?

Believe it or not, there is an answer to the chaos. Here's how to tame the chaos;

If you find yourself to be in a cycle of; failed, try to change, change, retreat to old habits, this is normal UNTIL you hire a company that holds your hand, guides you as an owner on the how-to in dealing with your team, and finishing the race (your day to day) feeling accomplished.

Overcome the dental dreary months.

The video here is of a doctor in Spokane, WA who was visited on the fly a year after coaching with us.

How can we help you overcome the challenges and leave you like this and many more of our doctors?

These months come and go, but it is your decision on how long they last.

Reach out to us, we're here to listen, plan and overcome.

The Insurance Paradox

Let's talk insurance and tools to use to get past the general feeling about it. Here is an exercise that I do with dental offices all around the country. We sit in a group, and we play a word association game.  I will say a word, and then you immediately say the first word that comes to mind.  Let’s try it.

  • CAT
  • TREE

I have no idea what you said for the first few words, but I’ll bet I can predict what you said for INSURANCE. You probably said something like “sucks” or “write off” or “thieves” or another negative word.  Was I right?  If so, read on.


This is what I call the Insurance Paradox.  Many of us as dentists have decided to voluntarily join up with certain PPO insurance plans. We are aware in advance that this will involve a contract with very specific terms. Primarily, we will have to abide by a fee that is often significantly lower than our standard fee. Will have to be aware of maximums, frequencies, waiting periods, and many other contractual obligations.   We enter these contracts with our eyes open, knowing the negatives, and understanding the positives. And then we turn around and moan and groan and complain about it while voluntarily re-signing that contract every year.

My first suggestion, of course, is to grow your practice to a point where you can reduce or even eliminate your dependency on network Insurance. However, many dentists live in areas or have practices where they are simply unable to do that. In San Diego there were several huge employers, all of whom seem to carry Delta PPO.

This is where my thinking seems to diverge from many dentists. I decided long ago not to be Mister negative about insurance. Not to constantly complain about it. And certainly not to transmit to patients that insurance was bad, evil, sucks, etc. Instead, I came with a positive view of insurance. The fact that it could significantly reduce patients costs was a good thing for me because I like my patients. I was their cheerleader in this.

There is a video in our library where we talk all about how to see and portray Insurance in a positive light. You will be shocked how this simple mindset change can increase your production.

If you find that being an in-network provider for dental insurance is increasing your blood pressure and decreasing your bottom line, I'd love to chat with you.  Let’s fix it!

Dentistry: Salary Increase

We have been having a lot of conversations lately with clients around the topic of a salary increase for their staff. Most of them seem to believe that longevity or loyalty has a lot to do with whether the employee receives an increase. Most employees think they deserve a salary increase simply because they have been there “a long time”.

Why have we forgotten that these are MERIT increases. These are not a reward for longevity or loyalty. Maybe some have forgotten the definition of merit.

merit [mer•it] verb
to be worthy of or entitled or liable to

Establishing Merit Increase for Employees.
Three things to determine merit increases:

If you are ending 2020 in a comfortable position and after speaking with your accountant have determined you can give increases to some or all of your employees, look at the body of work your employees have accomplished. Give your highest performers a bigger percentage and your lower performers a smaller percentage or no salary increase.

Three things to determine merit increases:

Do I give out a salary increase this year?

Employees only do what is in their job description earn their current pay rate and the benefit of keeping their job. Unlike the employee that goes beyond that and shows initiate or refrains from water cooler talk that is toxic to the practice. That employee deserves an increase.

More importantly communicate with your team on how you are determining increases. Make sure they understand how to earn a salary increase. Merit increase are not a given. No longer the days of cost-of-living increases. They were never enough to keep up anyway.

Work with your employees. Help them understand where you stand on salary increases. Increases are earned by those who do MORE than the job description.

A Dental Patient’s Amygdala Hijack

I have become extremely conscious of the relationship between a patient’s emotional state and ultimate practice success.  To some, that may seem like a bit of a reach. Have you ever spent time thinking about your dental patients and what the role of the amygdala plays in case acceptance? The amygdala hijack is powerful and shouldn’t be disregarded.

The amygdala is part of the brain located near its base. It is the source of strong emotions: fear and pleasure, for example.  The term “fight-or-flight” originates from early humans, who were potentially exposed to the threat of death or injury much more often than we are in the modern day. When a person feels threatened, the amygdala is what is in charge of this response. In modern times, the amygdala can be triggered by anxiety, fear, or similar emotions. It will signal the release of hormones that evoke the fight-or-flight reaction.

Sometimes, people can control or even override this reaction by using other parts of the brain, specifically the cerebral cortex. This is the part of the brain that is used to make more thoughtful and rational decisions.

The “Amygdala Hijack”

Psychologist Daniel Goleman coined the term “amygdala hijack” to refer to a time when the cerebral cortex is simply unable to override the amygdala.   Imagine you are taking a nice hike through the woods.  It’s a beautiful day. You are noticing flowers, the birds, the clear sky, and the lake off in the distance. Suddenly, you turn the corner and in front of you is a big rattlesnake. (Or maybe a bear depending on where you live.)  Your amygdala will immediately assume control of the situation. You will forget about the surroundings.  Your blood pressure will rise and blood will be sent immediately to your legs and other major muscles in case you need to run or fight.

The organs that are not essential will slow or even stop. Your airway will open as much as possible to take in more oxygen.  Your pupils will dilate to allow more light and improve your vision.  You are now ready to fight or flight.

While there may not be a rattlesnake or bear in your dental office, many patients are in a state of controlled or partial amygdala hijack when they’re sitting in your operatory. The courage required just to walk in your office door was huge.  Of course, their cerebral cortex  is forcing them to control or suppress their emotions. They breathe in what seems like an odd way in an attempt to control the situation.  What they really want to do is fight or flight.  (If they choose one, let’s hope it’s flight.)   

During a patient’s treatment, we can use calming techniques like relaxed words, headphones, nitrous oxide, medications, etc.  That said, in non-treatment moments, like a recall exam or limited exam, if that person’s amygdala is overriding the cerebral cortex, he or she is literally unable to devote as much brain power to understanding our consultations.   This is why I strongly recommend that if you are fortunate enough to have a consultation room in your office, it be used to discuss treatment.

All treatment, no matter how small.  Of course, the consult room is still in the dental office, but it is not in the middle of drill and suction sounds, scary looking instruments, etc. We should also ask patients if they’d like to see close up pictures of scary things before we put an intra-oral photo on the monitor or TV.

I am thoroughly convinced that case acceptance is much higher when a patient is in the correct moment to hear and understand treatment.   If the amygdala is controlling the moment, the patient will usually say something like “I’ve got to think about it” just so he or she can get out of there…. flight. 

A huge part of this is improving treatment plan consultations and therefore case acceptance.  If you are ready to take your consultations, and therefore your production, to the next level, call us. We are here for you.

Perio Percentage

As a dental office Coach with Accelerate My Practice, Inc. (AMP) there are many things my fellow Coaches and I research when we visit dental offices all around the country. One item that is very important is what we call the “Perio Percentage.” 

The Perio Percentage, simply put, is the number of periodontal procedures (scaling and root planing, periodontal maintenance, etc.) expressed as a portion of the overall amount of hygiene procedures. Mathematically, we will calculate a fraction, where the numerator is the amount of periodontal procedures and the denominator is the total amount of hygiene procedures.

For Example

Let's say in a certain month, a hygienist sees 120 hygiene patients.  Of those 120 visits, 95 of them are adult prophylaxis and 25 are periodontal in nature as described above.  In this example, the Perio Percentage would be 25/120 or 20.8%.  

According to the CDC, in the general population about 47% of adults over 30 years of age have some sort of periodontal disease.  That number climbs to over 70% in adults over 65 years of age.  Per our research at AMP, in a healthy practice, the Perio Percentage is a minimum of 30%.  In an office that serves an older demographic, it should approach or exceed 40%.

A nice high Perio Percentage really means two things: first, and most importantly, we are providing excellent care for our periodontally involved patients. Second, our production will be higher on an hourly basis since the fees for periodontal procedures tend to be higher than that of standard adult prophylaxis.  And that’s without any increase in overhead.  So, everybody wins!

If your percentage is too low, it's likely due to one of two things.

I will discuss both of these factors and how we can improve our Perio Percentage in future blogs.

How the CARES Act Impacts Business

One of the hotter topics for all businesses is how the CARES Act impacts their business and specifically the SBA loans are being administered. Today I had the pleasure of interviewing Stephen Custer of DMLO which a large accounting firm based in Louisville, KY. Stephen is not only a CPA but also an attorney, so he is a wealth of information on this topic. If you want to see the video recording of this interview, you can find it at www.Facebook.com/AccelerateMyPractice. For more detailed questions on this topic, I would suggest reaching out to DMLO via their website or phone number, www.DMLO.com or 502–326–2376

A big challenge we face with the CARES Act is that it is ever changing. The information we have today could become outdated in a week or two. We stalled a bit doing this interview waiting for the speed of change to slow down. So hopefully everything we do write here remains relevant, but do understand this is being written and published on 4/15/2020.

Timing — The timing of when to take your PPP loan is of vital importance. Once your loan is closed the bank is required to fund your loan within 10 days. Meaning you will have your cash within 10 days, which is good news. If your business is not considered an essential business and you can’t work, you will have a challenge. When the loan is funded, you will have 8 weeks to spend 75% of these funds on payroll. After that point your “forgiveness rate” starts to become modified. It is really a challenge to say the least. The smartest thing you can do, is wait as long as possible to close your loan. That way you don’t get it before your business can even open. Side note, this might be a great thing to write your elected officials about so perhaps the Treasury Department changes these rules ever so slightly.

Proper use of Funds — A business can use these funds for anything really, but your forgiveness is entirely based on your using these funds for qualified things. These are: payroll costs, mortgage interest (for mortgages that existed before 2/15/2020) rent and utilities. You have to use at least 75% of the funds for payroll or again your forgiveness rate will change. We were unable to gain clarity at the time of this interview if payroll taxes were a qualified use of funds. They might not be!

Repayment — the loans have deferral of interest and payments for 6 months. Meaning after you use the funds up, you will need to contact your bank and request the forgiveness. Provide evidence to your bank of how the funds were used in order to qualify.

EIDL loans — I have heard many conflicting things with this and within this interview we provided some clarity on the topic. If you took the EIDL loan prior to the PPP program launching, the amount you qualified for was likely reduced. At this point, most businesses with employees would be better suited with the PPP program. Personally I applied for an EIDL loan for one of my businesses and got an email back stating that business would only qualify for $1000 per employee. Which of course is dramatically different than what the rules were when I applied. For a sole proprietor business, you would have to run the math to see which option would be more advantageous. I don’t think anyone could make a blanket statement that one is better than the other without detailed information about your business.

In addition to the above, if your business didn’t lay off employees, you could qualify for employee retention tax credits. The last I read was $10,000 per employee. It is my understanding that you can’t do both tax credits and PPP for the same business. Businesses that also didn’t lay off can qualify for deferred payroll taxes, the keyword being deferred.

The bottom line with all of this is having a qualified professional giving you advice during this rapidly changing time is really smart. No one person can write an article that will provide you with sound advice without knowing your business precisely. If you lack this professional advice (CARES Act), I would suggest reaching out to DMLO at the contact at the beginning of this article.

Author does not claim to be a CPA or tax attorney, nor is he employed by DMLO. He simply found their advice to sound good advice that he could share with others.

How to Manage Cash Flow during COVID-19

Given the number of calls that myself and my team are fielding, there are plenty of cashflow fears for business owners. I want to share some thoughts on this topic, but please realize you will have to check your local listings on these topics. Each state is different and impacted differently, but I want to provide resources that will likely become available over time to you in your locality.

Over Communicate with the Team

The biggest thing every business owner needs to do is over communicate with their teams. Much like you owners have fears about your futures, your employees do as well. So let them know if they will have a job when this ends. If they won’t, let them know now so they can start planning. I bring this up because one option you can utilize if your business has been asked to close by your local government is unemployment. Many states have made changes in their policies with unemployment. Most have waived the waiting period meaning your team can get payment via unemployment right away vs the traditional 1 week waiting period.

States have also waived the requirement of seeking employment knowing most will return to their jobs. One thing that can be done to help preserve your companies cashflow is to furlough your employees. I do want to be clear about one thing, this won’t be an easy conversation for you to have. I am not suggesting this is what you do but it is one option for you. If you have the cash reserves to survive this lull and you decide that is the best thing for your team, so be it. I sure hope your practice has all of its maintenance done and cleaned amazingly then!

SBA Loans

Should you be short on cash, as areas are deem disaster areas, you would qualify for short term SBA loans at discounted costs. The current interest rates on these loans for for profit businesses is 3.75%. To see if your area qualifies, go to this site. https://www.sba.gov/disaster-assistance/coronavirus-covid-19

Contacting the Bank

I would also suggest contacting your banks and anyone you have loans with. Having spoken with management within one of the larger banks, they started creating contingency plans for this last week. I would assume each company will handle it differently. Some might let you completely pause payments and others might want interest only payments. But either way it will make cashflow easier for you.

Lastly, from a cashflow perspective, if you have and emergency patient in the chair, you might as well get as much done as the patient is willing to do. They are there, and you have a light schedule and they likely are only returning home, get as much done while there as you can. It only makes sense.

Take a deep breath to calm yourself and wash your hands. This too shall pass!

Impact of COVID-19 on Dentistry and Dentistry’s Impact on COVID-1

I want to weigh in on this topic of COVID-19 for our industry and offer a few thoughts of preparedness you might want to consider. First I want to offer some facts on the topic and to be clear these aren’t my facts but rather from either the CDC or WHO and I will reference all my sources at the end if you want to read them yourself. I share all of this because between the media and social media, it is very difficult to get to what is real, so I will provide what I believe to be credible sources of information. The reason why this is important will be obvious to some, but not all.

Misinformation about COVID-19 is causing widespread panic and resulting in people stockpiling a years worth of toilet paper as an illustration of the level of the insanity in the world right now.

COVID-19 Facts

According to the CDC the seasonal flu in the US in 2017–2018 resulted in 61,000 deaths and 810,000 hospitalizations with 45,000,000 illnesses. This works out to a case-fatality rate (CFR) of 0.13%. In the years 2016–2017 it was 38,0000 deaths and 497,000 hospitalizations for 29,000,000 illnesses. This is a CFR of 0.13% as well.

As of 3–13–2020 in the United States, there have been 41 deaths for total reported cases of 1,629. This works out to a CFR rate of 2.5%. This CFR rate is expected to change quite a bit because of the test methods being limited to those who had foreign travel. This change in testing protocol just changed this week. So likely there are far more who have the illness but have not been tested. I am not under the impression that ultimately they think the CFR rate will go up or down. I think there is too much unknown at this point.

COVID-19 Transmission- One of the challenges creating some the hysteria is that there isn’t enough known about how this virus is spread. It is thought to be spread via liquid sprayed from a person to another via cough or sneeze. There is thought that the virus can live for some time on a hard surface such as a door knob. No evidence of its transmission via water but has been found in feces. Some early evidence shows that a person exhibiting no symptoms could be contagious. This is disturbing for sure. Lastly it appears as though the incubation period for this virus is about 5 days and the symptoms appear to develop in about 11 days.

What does it all mean?

If you are a “normal healthy” person, the likelihood of death from COVID-19 is quite low. Now that being said, you might be miserable for 2 weeks while you recover from it. So clearly, not getting sick is the best method and hence the world closing most all large gatherings lately. So the odds of your dental office being impacted with no shows and cancellations is quite high. The fact that many schools across the country have closed is going to impact every parent in this country and create employment challenges for them all.

What could happen next?

My prediction if things continue to get out of control is this. Assuming hospitals start to overflow and can’t handle the volume of people needing or wanting to be tested for COVID-19, public health officials are likely to seek other facilities and teams to do this testing. I see them next turning to medical and dental schools to be transformed into triage facilities for testing and potentially treatment. In areas that lack these facilities, I could see a potential of public health officials tapping into surgical facilities and dental offices. Think about it, where else are their facilities and employees with asepsis training and capabilities? If things get out of control, I think this would be a real possibility.

Now that I have shared my doom and gloom prediction about COVID-19, I think the more likely is something less dramatic. I for sure see economic loss for business owners as a result of this crisis. If we as trained professionals can calm the public and teach them logical things to do, such as good hygiene, the severity can be decreased. Sadly, there is plenty of the opposite of being level headed.

The worst story I have heard thus far was from a physicians assistant who took a call from someone asking if they were at risk because they ate Chinese food last week. Now I am not trying to pick on this person’s ignorance. This level of ignorance and then inciting panic as a results with similarly minded people will stir the public into a frenzy. My greatest concern for this country and world isn’t the sickness but the damaged caused from the panic.

Mindset matters

I have studied neuroscience for the past 10 years and here is a super short lesson on it. The frontal lobe of the brain is responsible for many things but relative to this, judgement, planning and problem solving. The amygdala by contrast is responsible for the processing of emotions and specifically for this purpose, fear. When one becomes fearful, the body shifts blood flow from the frontal lobe to the amygdala so it can decide whether you should fight or flight. Clearly when you see people fighting over toilet paper in Costco, I can tell you where the blood flow in their brain is and it sure isn’t to the problem solving portion of the brain. One’s ability to solve problems during this “triggered” time is quite low. The problem is that right now we all need better problems solving skills!!

What can you do?

What can you do to be more rational during tough times? Some simple things can help. Just stop and take at least 10 really deep breathes. This will not only help you make better decisions but also help to boost your immune system during a time when we all need this. You will find a calm at the end of taking deeper breaths. Another technique we teach all the time is to change your focus. Being entirely focused on the terrible news or social media feeds that are “scaring” you, you will create a perfect storm in your brain.

If by contrast you can find something positive or bright in your day, celebrate something, enjoy a moment or anything to pull your attention away all off the doom and gloom, again you will shift the blood flow in your brain and dramatically increase your problems solving skills. Now some of you might be asking yourself the question, but I don’t have something bright today or something to celebrate? Look harder, of course you do. Maybe you don’t have COVID-19, or your family doesn’t or you still have a job, or your son or daughter is desperately seeking your attention during this scary time. You should be thankful you have this son or daughter. If you even try a little bit you should be able to create a list of reason to be thankful for!!!

I have great concerns for anyone who has health issues and I am equally concerned for the impact of the panic on our children. This virus has the ability to dramatically negatively impact our children for years to come. The economy will recover, our health for most of us will recover. The emotional scars of any of us acting like fearful idiots could leave life long scars on our children. My advice, calm down so you can calm your family. Turn off the news and turn on a family comedy. Laughter can very positively impact your immune system and your body as reported by the Mayo Clinic.

The Dental Office and COVID-19

People in the medical community are seen, on some level, as experts in health and medicine. Act like an expert and talk sense into your patients, friends and families. Do what you can to attempt to maintain normalcy in your life and practice. But use every chance you have to inspire hope and calm into the public. You have to live it to be able to lead people to it. If you need someone to talk you off the ledge of panic, hit our website (https://acceleratemypractice.com) where we have people standing by on our chat that can offer you some peace in the storm. It would be our pleasure to serve you and help you and your team during this crisis. We can offer you ideas with your practice, patience and family. We are here to support and serve you!

In the meantime I would suggest writing/publishing a Facebook, YouTube, email message to your patience explaining the following. Infection control measures that have always existed in dentistry and were designed such that dental offices assume all patients are infected with something. Meaning, there is no safer place in this country than a dental office. For sure safer than your local grocery or big box store. I would scream this message from the roof top!

From a social distancing perspective, consider having your patients wait in their cars for you to call them in. Patients and staff members are able to stay in a safe spot but yet still get done the things that need to be done.

A Healthy Mouth

Also, one of the best ways to prevent you contracting any illness is to ensure your mouth is healthy. One of the biggest pathways for disease into your body is your mouth. An unhealthy mouth would be far more prone to infection than a healthy one. In addition to this, if you body is busy fighting oral infection, it is taking away resources to fight other and potentially more important infections. There is no better time to have great oral health than now!! I would also passionately share this message with your patients. Feel free to cite the resources I have as evidence to support this message.

Bottom line, the dental office is a very safe place to be right now. Patients can get sound professional advice on public health topics from dental professionals. There is no better time to have great oral health than right now.

Be the calm in the storm for your patients and wash your hands!

Sources & References

What Kind of Leader are You?

Taking a break from the traditional post this week in the wake of the recent tragedy that happened in California.  During times like this it can be beneficial to look at what lesson is in this?

At times that seems impossible; however, sometimes strength and courage can be a result of something horrible.  The passing of nine innocent lives in a helicopter crash seems like something that is beyond a lesson. Dig deep and look at the words of one of the world's most iconic sports leader.

“The important thing is that your teammates have to know you’re pulling for them and you really want them to be successful”   - Kobe Bryant 

It begs the questions, what kind of leader are you? 

Are you expecting your team to create the results you are looking for? Are you leading them to the results you want to achieve?  Who is standing at the helm of your practice and your life?

Who is taking charge and pulling for the people that are going to be there when you achieve what you are looking to do?

It could be you're practice or a life journey, just know you won’t get there alone.  The lesson to learn here is to make sure your team knows that you want them to be successful.

AMP will continue to pray for the lives that were lost as a result of the tragic helicopter crash in California on January 26, 2020. Always respect what Kobe Bryant did on and off the court in his journey to not only be a tremendous athlete but also a leader of people.