By Pat Cunningham and Dr. Jeff Carter, T.H.E. Design
Photos courtesy of T.H.E. Design
Editor's Note: This "Office Spot-light" is very unique. Pat Cunningham and Dr. Jeff Carter of T.H.E. Design have conducted in-depth interviews with Dr. Gary Wolfson of Engelwood, Colo. The first part of the interviews (conducted by Cunningham) takes place just days after Dr. Wolfson moved into his new office. The second part (by Carter) is recorded nine months later. To see how an office can truly transform a dentist and his or her practice is amazing, as you will see from reading this article. Enjoy!
Part I by Pat Cunningham
I love talking to dentists about why they decided to design a new facility. While the reasons may be unique from one dentist to another, all dentists begin with the "dream" and the belief that what they set out to do would, in fact, become a reality - their practices would thrive and they would know they made the right decisions.
But until the office is complete, it still is just a dream.
Afterwards, they share about the surprises and delights (all the things that went well) and the disappointments and obstacles (how they solved the problems, learned the lessons, and moved on through) until it was complete!
But what we really want to know is that they survived. I don't mean the process. I mean that they actually saw that first new patient walk through the new door; they actually presented a case in the new consultation room and the patient said "Let's do it!;" they actually completed that first full month's production and it did feel easier; they made that first payment to the bank or paid that first month's rent; and we see a smile on their faces as they talk about the reality that used to be their dream and we can see they are just fine. No, they are more than fine - they survived!
This gives the next dreamer hope. Which is precisely why Dr. Gary Wolfson's office is the perfect feature. This office had special meaning for us at T.H.E. Design, Inc. We wanted to "track" a dentist from his existing practice and existing office space to the new facility and practice growth. Dr. Wolfson agreed to be that doctor.
I interviewed Dr. Wolfson only four days after he moved into his new office. The staff had worked innumerable hours getting everything ready, the general contractor was completing the details of the final punch list, and they already had seen 25 patients. You could feel everyone's anticipation.
From the beginning, Dr. Wolfson brings a wonderful perspective - the edge of the paradigm shift. It is exciting - the office is complete, the doctor and staff members are ready, and it is just the beginning. However, we need to go back to where he first began thinking about this dream.
"I wanted to change the demographics of my practice," were Gary's opening remarks as we sat down in his new consultation room to talk. And so, the process started, there in his existing office located between Blimpies and the State Farm Insurance office, about five years ago.
"I've been practicing for about 19 years, but six years ago, I knew I needed to change my office somehow," Dr. Wolfson said. "We had a good solid practice and great patients, but I wanted to offer more to my staff and to my patients. It occurred to me that our practice was like the 'local dive' restaurant - great food, but no street appeal.
"Anyone driving by our office who didn't know us couldn't appreciate what we had to offer because it 'looked' like it didn't offer much. So I started looking. It was nonchalant at first, and then got more intentional as time passed. I discovered pretty quickly that there were very few options in my area. Anything that might have been available wasn't really going to improve the office image much from its existing image. In l998, however, a space that I actually liked became available. It was fortuitous, because I also was registered to attend T.H.E. Design's conference in Boston. My thoughts were probably pretty predictable.
"At last, I might actually get this dream off the ground! I just knew how this would work. I would attend the course, learn more about designing a dental office, return home to sign the lease, and get the project started.
"First of all, I learned so much more about what was involved in 'getting the project started' than I could ever have anticipated. Second of all, 'starting it' was only part of the puzzle. I had to decide how and with whom I was going to get it designed, how and with whom I was going to get it built, what I was willing or able to invest, and how I was going to have it all completed by the time my lease was up.
"For me, the decision to proceed was a decision to go into debt. This was the biggest hurdle for me. Prior to the course, I figured a 'typical' dental office might cost $150,000. The whole time I had been looking at spaces, that's precisely what I thought it would cost - until I went to the course. I learned that I hadn't factored in all the costs associated with a project. Most dentists don't, and then they are surprised. I didn't want that. I found out that what I dreamed of wasn't going to be $150,000. That, in fact, was the dream.
"So there I was. Three-plus years into this and trying to decide whether to do it at all. I'm conservative. I think most dentists are. The thought of taking on debt was like starting the practice all over. Did I really want to do that?
My decision was very clear by the end of the next day in my existing office. I could hear a patient asking about his bill at the front desk from the operatory. I reviewed a sensitive treatment opportunity with a patient at the chair while wishing there was a private area in which I could present. The staff had lunch on the same counter where we poured models. Hygiene was booking eight weeks out because we just couldn't fit recare patients in faster with three operatories. I could talk to everyone in the office from any location in the office.
Quality of life was important, even in a dental office! I was going to build a new office. Besides, I had plenty of time! I had a little over a year on my current lease. Well, it wasn't plenty of time.
- It took three months for me to secure a lease agreement. That was a surprise.
- It took three months to complete a design with T.H.E. Design. They told me that, so that wasn't a surprise.
- It took six months to secure funding. That was a complete surprise.
- It took a month to secure the building owner's "upfront" monies. By now, this wasn't a surprise.
I soon realized that I had a 11/2-month gap between getting kicked out of the old office and completion of the new office. I was going to have to find an interim office. This was a total shock!
It took three months to find the interim office. I was getting numb. Construction took four months to complete - which was within days of when the contractor predicted. That was a blessing.
The entire project took 11/2 years from my "start" time. I couldn't believe it! I am a perfect example of the "best laid plans ..."
So, here we were - Dr. Wolfson and I, four days in the new office. He was excited, relieved, and very proud of the result.
"It is just now sinking in. No, maybe it really hasn't yet. I wanted an office that would make my staff, my patients, and myself proud. I have that now, but it hasn't registered yet. I haven't made the first payment yet, and I haven't completed the first presentation in my new consultation room yet. I keep hoping the patients are going to come through that door. I keep trusting that I made the right decision. I'm right on that edge that feels like something really big is going to happen, but I haven't quite figured out what yet, which is kind of odd when I can see it."
This is the paradigm shift. The dream is becoming the reality, but it is not quite there.
"I can't stop smiling, but I don't fully grasp why. This was incredible to put together. I was so totally immersed in the process of getting to this point that I just don't know how to respond to this point yet. I can definitely tell you one thing, even before I've paid that first month's rent: This is what every dentist needs to have after many years in practice.
"I am realizing that I needed this. I needed to surround myself with an office that looked like what I was doing. We provide dentistry to patients who want the best for their dental health. We provide comprehensive cosmetic and restorative care, and now our patients can see that.
"It is almost indescribable. My mood is lifted every time I walk in here. I am proud and can hardly be-lieve that what we have all worked so hard for is here.
"Patients and friends keep tell-ing me that I deserve this and that I did a great job. I'm not really sure what that means. But I am sure that it has something to do with how we as dentists don't know how to receive compliments, especially about our offices or our practices. This is probably because we don't know how to respond to something we've never heard before. It's a terrible thing to realize that - from dental school on, for an entire career - we rarely hear positive comments from our patients or staff."
Part II by Dr. Jeff Carter
The story of Dr. Wolfson should "hit close to home" for many of you who are near the midpoint of your careers as dentists. In fact, general practitioners like him and thousands of others represent the backbone of the profession - doctors who are out there everyday doing "what it takes" to care for people. Maybe they actually provide the care or maybe they opt to guide patients to other more qualified professionals. For 20 years, the public has been asking - and, on occasion, even demanding - that Gary help them with their teeth. Practicing dentistry for 20 years is a pretty remarkable thing.
A little history may help. When many young boys were announcing adult occupational goals such as a genetically altered superhero, a 6-year-old Gary selected something real and reasonable beyond his years at the time. He selected dentistry.
After "slacking off" through most of first and second grade, Gary got serious about his studies and fulfilled the academic requirements to get accepted to dental school in 1976. He graduated from dental school in 1980, then practiced for a year in an Air Force clinic for family dependents.
After gaining some "real life" practical experience, Gary sought out an appropriate location to set up his own practice, which had been a goal of his since childhood. He found a location in a newly constructed retail complex. The area was comprised of homes under construction in every direction. "What a great place to start a new practice," Gary surmised - and rightfully so.
Gary secured a loan and signed a lease on the 1,200-square-foot space. Some of you may remember that, in 1981, the prime lending rate was around 18 percent. A 27-year-old Gary got the "welcome to the business world" rate of 21 percent to start his new office. Through the guidance of his general contractor and dental-equipment supplier, Gary designed, constructed, and equipped his new office.
Gary survived those early years when you could impress your buddies from dental school with monthly productions numbers of $7,000 or $8,000 a month. The area around his office continued its rapid growth to the point that it was no longer on the edge of the city, but in the middle. Unfortunately, much of the "urban-sprawl" growth was the type that does not always age gracefully and does not take on more character over the years. Gary's practice growth precisely "mirrored" the plight of the surrounding area. The new growth areas had moved on and the retail shopping area had lost most of its initial appeal. Gary was not attracting the kind of patients his level of skill now warranted.
His yearly production total peaked in 1996; total production during the next two years actually declined. Not only was Gary unable to routinely practice the comprehensive and cosmetic care upon which he wanted to base his practice, his personal income was in decline.
Gary had some "soul-searching" to do. He had spent the last 17 years building this practice, and for what? To find out from his practice-management consultant, Amy Kirsch, that he would have to move to a different location just to keep his production numbers where they were. In addition, Gary also was going through a painful divorce with children involved.
Just as you and I would probably do in the same situation, Gary began to question many of the major decisions in his life. He was having the "double whammy" midlife crisis - career and personal life.
Gary decided he was too old and stiff to run away and join the circus. Instead, he made a major life decision to take on new debt (after being debt-free in his practice for years) to create the type of office that would hopefully turn things around. Eighteen years earlier, Gary had stood there clueless while his general contractor and equipment supplier designed his office. This time, it would be different.
Progress on the new facility came quickly and in an almost predestined chain of events. Seven miles from Gary's existing office, a lease space became available in a new medical professional building. The area was a well-orchestrated mix of new growth and existing high-quality construction, both commercial and residential.
For years, Kirsch had urged Gary to attend T.H.E. Design's Dental Office Design Confer-ence and get educated on how to design, finance, and construct a "state-of-the-art" office. The conference was taught by two of the profession's most respected dental office design educators, T.H.E. Design's Dr. Harry Demaree and Pat Cunningham, IIDA. Gary took Amy's advice and went to the 1998 design conference in Boston.
In the first hour of the conference, Gary recognized a very key concept. Unlike those funky, aging restaurants that still attract customers seeking great food, tired and out-of-date dental offices do not attract patients seeking great dentistry. If a patient enters your reception area and it has attributes such as shag carpeting, posters thumb-tacked on the wall, and a harvest gold and avocado green color scheme, they associate your dentistry with the 1970s or, even worse, the late 1960s.
Based on the conference content and presentation, Gary chose T.H.E. Design, Inc., to design his new "state-of-the-art facility." Unlike Gary's first office, the new facility design was an exhilarating integration of dentistry, architecture, interior design, practice-management principles, and cutting-edge technology. It took three months to complete the extensive design process in which Gary was an integral part of every step. Rusty Nail, T.H.E. Design's highly recommended general contractor for the Denver area, was hired by Gary to do the project. The same Rusty Nail that had built and continues to build the most outstanding offices in the area, including the nationally recognized and awe-inspiring facility of Dr. Charles Fischer. And, in another ironic twist to this story, the same Rusty Nail that helped design and build Gary's first office 18 years ago!
With completed drawings in hand, Gary next encountered delays in acquiring permits due to the huge construction boom in the Denver area, and funding delays with his tenant finish-out allowance from the building owner. It took 11 months to design, finance, and construct Gary's new 2,100-square-foot office.
As Gary would tell you, "Have a back-up plan if your project gets delayed." Gary's lease on his first office expired eight months into the process and he was unable to negotiate an extension. Instead, the retail center's management was eager to have a cigarette store move into Gary's old space. In October of 1999, the cigarette store flicked Gary's "butt" out onto the street. For the last three months of the construction process, Gary shared office space with another gracious dentist in the area.
Gary and staff moved into the new facility on Jan. 4, 2000. The space had turned out beautifully. Gary and his T.H.E. Design team had carefully selected finish materials that would have broad appeal. A lot of male doctors, if given the opportunity, select things like mallard duck wallpaper with shotgun-patterned accent borders to go with their framed photograph collections of gaffed, semiconscious marlins. Gary knew his patient base was 65 percent female - meaning there would be a lot of moms, professional women and kids - along with his reasonable share of male duck hunters. Gary's new office had a totally different "feel" than the typical dental office.
What do we mean by feel? Imagine you are a patient new to an area, trying to locate a facility and doctor to provide $20,000 worth of comprehensive dentistry. What kind of feel would you want a dental office to have?
You might be wondering what kind of investment Gary made to create this different "feel." His total project investment was approximately $375,000, which included a very helpful $73,500 finish-out allowance from the building owner.
Recently, a walk-in patient approached Gary's front desk and requested six anterior veneers for her upcoming wedding. A new patient in the area selected Gary's "state-of-the-art" facility as the place she "felt" best about having 10 units of crown and bridgework completed. A practice that was stagnant - and even in decline - is now trending significantly upward. Gary is attending more continuing-education courses than ever in an effort to provide the kind of high-quality comprehensive and cosmetic care his practice demands.
Practicing dentistry for 20 years is a pretty remarkable thing.
Autoclaves/Sterilizers...Pelton & Crane, Steam
Cameras...Yashica Dental Eye
Chairs...Pelton & Crane Chairman, Belmont Excalibur
Cleaners, ultrasonic...Biosonic UC300R
Compressors, air...MDS Matrx
Impression materials...Jeneric Pentron, Correct Bite
Intercom system...Porter Light
Intraoral camera...Ultracam II
Lights, curing...Optilux 500
Lights, operating...Pelton & Crane, Track
Nitrous oxygen units, accessories...Porter MXR
Stools...Pelton & Crane
Vacuum units, accessories...MDS Matrx
X-ray processors...Phillips 810
X-ray units...Siemens, Hedont MD, Orthopantomograph 5
To cover the debt service and operating costs associated with the new facility, Dr. Wolfson needed to produce and collect another $6,353 per month. Was it worth it or is it too soon to tell? You decide.
Net production increase in new facility vs. 1999 monthly production average in old facility:
1999 average in old facility = 13 new patients per month
2000 monthly new patients in new facilit
Production per exam
1999 average in old facility: $210
1st quarter average in new facility: $407
2nd quarter average in new facility: $467