Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 61

Practice Management Diary

Renovation: The Slippery Slope
Dr. Jeffrey Nichelini
American Canyon, CA

In 2016, I acquired the satellite practice of my
dreams. It had been an established practice for
more than 40 years, stewarded by generations
of orthodontists beloved by the small community
it served, which was full of my own family
members. The acquisition also came with the
opportunity to run the practice with a good
friend and mentor for whom I have great professional respect. With the honor of continuing
an old tradition, however, came the burden of
working in an old office.
Our newly acquired office had stained carpet,
clogged plumbing, dripping faucets, peeling
paint, retro-chipping cabinetry, flickering overhead lights, fluorescent lighting, and scant modern amenities such as powered dental chairs.
It was not the kind of office that inspired confidence from new patients. Initially, we reasoned
that if the condition of the office had been good
enough for the previous doctors, then it should
be good enough for us, too. Besides, neither of
us wanted to devote more time or money to an
office that we had just paid to buy out, an office
that was already absorbing more attention than
our families would like.
One Thing Leads to Another
Our prudence was thwarted the day a chair gave
out. Safety demanded we get new chairs. No
problem, we thought: four beautiful new chairs
shouldn't be too expensive. But what color
upholstery should we get? Certainly nothing
to match the dated décor, we agreed; let's think
down the road and envision how we will want
this place eventually to look. For a few thousand
dollars more, we could get a designer to put
together a long-term plan. Oh, some ceiling
lights have gone out, and the panels are bad?
Fine, the designer is working up a plan; we'll just
redo the lighting now instead of later. But wait,
the front desk is not set up appropriately for two
people and it is not ADA-compliant. Well, we
already need an electrician to redo the overhead
lighting, so we might as well get a new front

desk. Oh, but if we change the front desk footprint, we will need to redo the floor. Fine, put it
on the tab, and while we're at it, I don't like the
look of the side units. A project that started with
wanting newer and safer patient chairs has
become an extensive undertaking that includes
a general contractor and shutting the office
down for two weeks!
Controlling the Slide
Defining the scope of the project is a struggle.
Even though we have committed ourselves to
the renovation project, we don't want to spend
more money than what is justified by the production of the office. Objectively, there are certain
items that must be updated immediately, such as
the faulty dental chairs. Subjectively, we expect
that esthetic enhancements will translate to
increased production through increased case
acceptance, but the time required to recover the
improvement costs restricts how much money
we can justifiably invest.
Understanding expectations of our return-oninvestment can help us set a reasonable budget.
Current interest rates make the debt service for
every $100,000 of a construction loan approximately $1,000 per month on a 10-year term.
Considering the fees for an average full-service
orthodontic case, we can extrapolate that every
$100,000 of construction loan will require the
addition of two new cases annually for 10 years
for the investment to pay for itself, but our little
satellite office only serves a community of 6,000
people, so our expectations of increased production has to be very conservative or we risk a large
amount of wasteful spending. Practical realities
of any construction project, however, make conservative budgeting difficult, and construction
costs are currently at a premium in the North
Bay. Our situation leaves us with the reality that a
full-scale remodel would be cost prohibitive and
our obligations would be more extensive than
our budget could support.
continued on page 62

Spring 2018  PCSO Bulletin

61



Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Spring 2018

Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 1
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 2
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 3
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 4
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 5
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 6
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 7
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 8
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 9
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 10
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 11
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 12
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 13
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 14
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 15
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 16
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 17
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 18
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 19
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 20
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 21
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 22
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 23
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 24
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 25
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 26
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Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 28
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Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 32
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Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 37
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Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 40
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 41
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 42
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Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 44
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Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 46
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Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 49
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Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 58
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Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 60
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 61
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 62
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