# High tech - an expense or an investment?

June 1, 1998
Anyone who has visited my office knows that we probably have more high-tech equipment and gadgets in our practice than just about anyone I know. There is virtually nothing available that we haven`t considered, tried or bought. It can get very confusing and scary when you are contemplating a serious capital investment and a dozen salesmen or dealers are putting on the pressure. How do you decide what, if anything, to buy?

Stewart Rosenberg, DDS

Anyone who has visited my office knows that we probably have more high-tech equipment and gadgets in our practice than just about anyone I know. There is virtually nothing available that we haven`t considered, tried or bought. It can get very confusing and scary when you are contemplating a serious capital investment and a dozen salesmen or dealers are putting on the pressure. How do you decide what, if anything, to buy?

Well, I think there is a method to all this madness that has worked extremely well for us. In fact, we`ve never made a serious mistake in any major purchase in 31 years of practice. I would like to share our decision-making process with you.

Ask for trial period

What we do whenever we see something that we think may benefit our practice is a very simple exercise. First, we must be certain that the product really does what it is supposed to do. So, we insist on a reasonable trial period with a money-back guarantee in case the product doesn`t perform up to our expectations. Assuming that it is as good as we think it is, we do a simple math exercise to determine whether or not we buy the product.

We take a piece of paper and draw a line down the middle of the page. The left-hand column is titled "cost per month" and the right-hand column is titled "production per month." Now, notice, I said, "cost per month," not "cost of the item." That`s because I don`t care if it costs \$500 or \$59,000, as long as my production per month exceeds my cost per month.

If the product costs me \$200 per month and I generate \$2,000 a month in income from it, I net \$1,800 for every \$200 I spend and that`s an investment with a healthy return. On the other hand, if I only generate \$100 a month and I`m losing \$100 a month, that`s a lousy investment. It`s now an expense. We dentists have too many expenses already! We certainly don`t need any more.Unfor-tunately, most of us keep piling them up instead of making prudent investments that will increase our net worth.

Most of us are suckers for anything out there as long as it costs less than \$1,000. We buy all kinds of composites, bonding agents, impression materials, gadgets, widgets, and other junk that gather dust and rot on our shelves, never earning us a dime. Eventually, our assistant gets tired of looking at or moving it every time she goes into the supply room . We don`t give these expenses a second thought. Everything that fits into that category is an expense. It goes on the left side of the page with a zero on the right.

On the other hand, we agonize over anything that costs more than a few hundred dollars, even though it may make us thousands in return. When I bought my first laser in 1989, I spent \$24,000. It cost me \$600 a month on a five-year lease with a \$1 buyout at the end. With all the procedures we now could do - procedures that we used to refer out or ignore - I quickly realized I would have to stop seeing patients to not do at least enough to double or triple my monthly investment. I was referring out more than that! So we made the purchase and the first year generated \$128,000 in additional income for a \$7,200 investment.

Since that time, the additional cost for maintenance and supplies has been about \$500. Our production has been about \$100,000 a year. So, for a total outlay of \$36,500, we have generated about \$1 million in income. If that was in the stock market, you would jump out of your shoes to put your money up, but only 1 percent of the dentists in this country has made that kind of leap of faith. The rest of you thought we were nuts! Who was smarter: you who bought \$300 worth of stuff you threw away or me who turned a big profit on an investment that was a no-brainer once we did the math?

Great investments

My intraoral camera has made me a fortune, and my air-abrasion units and power-bleaching centers have been incredible. The cost of the curing and bleaching light I use was \$3,995, but we expect to net at least \$75,000 to \$100,000 from bleaching alone! These are great investments!

I meet many dentists who seem to really want to invest in new technologies such as air abrasion, cameras, lasers, rapid bleaching and curing to enhance their practices. And yet, they just can`t pull the trigger. They are confused as to what, if anything, to buy and are afraid to take a chance. My advice is to first decide what will work best in your practice to give you the greatest or fastest return on your investment.

An oral surgeon might first consider a laser. A CO2 laser would enable an oral surgeon to not only do more rapid and less invasive soft-tissue surgeries, but also increase the scope of his or her practice.

The oral surgeon could include new procedures such as skin-resurfacing and LAUP procedures for snoring and sleep apnea. For a periodontist, I would suggest an Nd/YAG or diode laser for subgingival curettage and minor-tissue recontouring or a CO2 for more involved cases.

Certainly, an intraoral camera is a must. For an endodontist, adding digital radiography and intraoral microscopes make sense.

For a general dentist, pedodontist or prosthodontist, choices become more confusing, depending on the character of the practice. I think every practice needs an intraoral camera, not just to sell the need for treatment, but as an important diagnostic tool. Postoperatively, it can help create value and patient buy-in for the procedures that you perform. As a result, the patient appreciates your efforts and doesn`t get buyer`s remorse.

Of all our investments, air abrasion has by far made the biggest impact on our practice. Others report the same phenomenal results. As a "bondodontist," I could not exist without rapid curing. My argon lasers and curing light save me about an hour or more per day in productive time. Obviously, a great investment! Our new power-bleaching center is a huge cash cow, while providing the most predictable results I`ve seen.

I have discussed several technologies that, in my opinion, are indispensable for every office to achieve better dentistry and increased profits. However, soft-tissue lasers might not be for everyone. A prosthodontist or cosmetic dentist might consider a diode or ND/Yag laser for troughing around crown preps, reducing gummy smiles, etc. Some, like myself, want to do more involved surgeries to create a new source of referrals or increased production.

Pick out what you want, do the math and see if it works for you. If a conservative estimate of potential production exceeds the monthly cost, just do it! Make an investment in yourself, your practice, and your profession. I promise you that production and profits will increase, you`ll have more fun and, more importantly, you will do better, more complete dentistry for your patients.

In addition to maintaining a busy practice in cosmetic and laser dentistry in Laurel, Md., Dr. Stewart Rosenberg lectures regularly on the integration and marketing of high-tech dentistry in the dental practice. He may be reached at 9101 Cherry Lane, Suite 202, Laurel, MD 20708 or by phone at 301-776-3300 or fax 301-725-1372.

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