The Financial Life Cycle of the Orthodontist - Utah Association of Orthodontists

PR E S E N TAT I O N FO R
Utah Association of Orthodontists
Friday –February 26, 2016
Copyright 2016. All rights reserved.
The Financial Life Cycle of the
Orthodontist
Business & Personal Financial Planning
Strategies for Dental Professionals

Cambridge Wealth
Counsel
Counsel. Plan. Prosper.
Robert Hockett, CFP®
robert@cwcounsel.com
w w w.cambridgewealthcounsel.com
801-783-2241
Off ices in Atlanta and Salt Lake City
- Ser ving Clients Nationwide -

Our Firm
• Fee-Only® Fiduciary—Comprehensive Wealth Management
• Founded in 1996
• Clients in 16 states—over 52% are licensed professionals
• Advisors have ~17 years of experience
Who we are » 1. Ortho Financial Life-Cycle » 2. Client Case Studies » 3. Audience Questions
Robert Hockett Barry Kaplan Brandy Wright

Our Dental Clients
Licensed professionals who desire to work with trusted experts to
accomplish their most important personal, family and business
goals—without conflicts of interest.
•Practice Types
• General dentists
• Specialists: Ortho, Endo, Pedo, Perio, Pros, Oral Surgery
•Financial Ranges for Dentists
• Personal Net Income: $225K to $1.35MM
• Total Net Worth: Generally $500K to $12MM

Our Wealth Services
• Goal setting
• Life and career coaching
• Cash flow analysis
• Insurance review
• Tax planning
• Estate planning
• Charitable giving
• Investment management
• Retirement planning
• Financing negotiation
• Business real estate consulting
• Strategic practice planning
• Dental practice purchase

“5 Star Wealth Manager
Best In Client Satisfaction”
Atlanta Magazine, 2006 – 2015
“Top Fee-Only Firms”
Utah Business , 2011
“ Top 10 Fee-Only Firms”
Atlanta Business Chronicle. 2004 - 2012
Recognition

Media Coverage

Presentation Overview
1. The Financial Life-Cycle of the Orthodontist
2. Client Case Studies
3. Audience Questions

Part 1.
The Financial Life-Cycle of the
Orthodontist

National Basic Facts
• Median income for Orthodontists (2014/2015)*:
• $481,150 Net Income (high $1MM)
• $1,200,000 Gross Collections (high $2.1MM)
• 10,571 – active Orthodontists in the U.S.
• 167,723 – active General dentists in the U.S.
• 210,036 – licensed dentists in the U.S**.
*Source: 2015 JCO Orthodontic Practice Study Part 1 Trends 11/2015
**Source: Professionally Active Dentists by Specialty Field 1/2016, Kaiser Family
Foundation

Regional Income Demographics
General Dentists
• Average income: $205-$225K
• Average collections: $775K
Specialist Practitioners
• Average income: $335-$347K
• Average revenue: $945K
Orthodontists (West Central Region)
• Average income: $500,000
• Average revenue: $1,264,000
*Source: 2015 JCO Orthodontic Practice Study Part 1 Trends 11/2015, ADA Annual Survey , 2014

Local Demographics
 Utah Dental Practitioner Statistics: 1,946
• 97.3% male, 2.7% female
• 1,538 General Dentists
• 137 Orthodontists
• 11:1 Utah Ratio of Dentists to Orthodontists
• 16:1 National Ratio of Dentists to Orthodontists
• 1,600 patients per dentist
Source: American Dental Association, 2014
Source: Professionally Active Dentists by Specialty Field 1/2016, Kaiser Family
Foundation

Big Dental Trends
• Retirement Age Extends (61/68/75)
• Debt Profile 350/500/950K in Student Debt
• Solo vs. Group Practice (30% Group Now)
• Corporate Dentistry
• Technology War –Expensive –Narrows Gap GP/SP
• Accepted Services “Creep”, Weekend Ortho, Invisilign
• Perceptions of Retirement Spending –too Low for 60% of dentists
• Govt Regs – 2013 HIPPA Omnibus Final Rule
• Required Agreements w/Vendors / 250-500K Fines
• Mandatory Disclosure for Cybersecurity breach (lost iPad)
• All computers recommended encrypted
• Be very careful and become compliant (1/24/2013)

Where do you fit in?

Financial Life-Cycle: Stages
=
Professional
Adolescence
Professional
Maturity
Full Financial
Freedom
Target Ages 28-40 35-60 55-90
Milestones Build financial
foundations
Wealth
accumulation
and advanced
planning
Wealth harvest
and preservation
Timeline

Financial Life-Cycle
=
Professional
Adolescence
Professional
Maturity
Full Financial
Freedom
Associate Income $136K – $300K $150K – $350K $150K – $350K
GP Owner Income $250K $350K – $550K Final 5-7Retirement
Ortho Owner
Income
$169K – $469K $469K – $1,000K Final 5-7Retirement
GP 401k Max year 8 Roth 401k + cash
balance x2
Creditor protected
Ortho 401k Max year 3 Roth 401k + cash
balance x2
Creditor protected
Additional savings Fund additional
investment accounts
Funding min. $120K
/ year
Tax strategies for
distribution
Income & Investments

Financial Life-Cycle:
=
Professional
Adolescence
Professional
Maturity
Full Financial
Freedom
Housing Careful, start
modest
Move to dream
home & pay it
down
Mortgage paid off
Student Loans Student loan
interest non-
deductible
Debt paid off Student loans
paid off
Personal Debt

Financial Life-Cycle
=
Professional
Adolescence
Professional
Maturity
Full Financial
Freedom
Business: Startup 10-15 year amort. Debt paid off 5-7 years – prep
sale
Business: Buy-in 10-15 year amort. Debt paid off Prepare for sale to
partners
Business: Purchase 10-15 year amort. Debt paid off 5-7 years – prep
sale
Commercial
Property
Save down
payment
Pay down building Building paid off –
rent to buyer
Business Debt

Why Stages?
• The three stages represent specific financial levels
of progress with the goal to transition through the
levels “on time” or early.
• The penalty for transition delay:
• Financial hardship for family
• Additional Broad Pressure:
• Increasing supply of “practitioners” (more grads + later
retirement)
• Technology War, Pricing Pressure, Corporate Practices

Your Goals are Important

Where do you fit in?
 Lack of knowledge can often be a
hurdle in reaching our hard fought
goals
 By helping our clients through the
three stages we have developed
tools, techniques and strategies to
speed up the transition process
Read our comprehensive
guidebook for Orthodontic
professionals—available soon!

Stage 1: Professional Adolescence
Timeline
•Time in Stage: 7-12 years
•Target Age for Completion: 40
•Milestones: Decide on Career Path, Develop Hand speed. Locate, Evaluate, Negotiate/Finance
Practice Purchase or Buy In, Set up “Best Practices” Operation. Set Personal and Business Comprehensive
Goals, Outline Personal and Business Budgets, Develop Understanding of Business Operations, Upgrade Old
Equipment and Systems in Practice, Solicit and Plan Personal and Business Tax Projections. Purchase Home.
Reevaluate Personal Budget. Evaluate, Place and Regularly Have Reviewed; appropriate cost effective Risk
Management in Auto, Homeowners, Personal Articles, Umbrella, Life, Disability, Health, BOP, Malpractice,
and Theft Insurances. Complete Comprehensive Estate Planning Documents including; Wills, Trusts, POA,
and Advanced Directives and Overcome Disagreements Regarding Guardianship of Minor Children. Evaluate
and Regularly Fund Investments, Outline Comprehensive Retirement Plan including Staged Savings
Amount and Optimal Location of Various Asset Classes. Negotiate for and Buy Building. Review, Set up,
Fund and Monitor a Practice Retirement Plan. Increase Production and Collections while maintaining
expense controls to move personal income into “Above Average Range”. Pay down student loans…interest is
no longer deductible. If Married – Stay Happily Married while having 1-6 children.

Stage 1: Professional Adolescence - 28-40
Beginning of phase End of phase
Associate income $136,000 – $300,000 $180,000 – $300,000
Owner income $169,000 – $469,000 $350,000 – $680,000
Housing debt $450,000 $750,000 (home #2)
Student debt $390,000 (max) $150,000 (min.)
Business debt (start-up) $500,000 $138,000 (12 yrs 5.5%)
Business debt (buy-in) $600,000 $166,000 (12 yrs 5.5%)
Business debt (purchase) $850,000 $247,000 (12 yrs 5.5%)
Business debt (property) $950,000 $606,000 (7 yrs 5.5%)
401k (GP) $0/year $53,000/year +$18K
Additional savings $15,000/year $120,000/year

Professional Adolescence - Stage 1
Milestones
• Review and set written personal and business goals
• Review and benchmark progress regularly
• Review personal and business borrowing for rate
changes/terms
• Review and upgrade your tax projections to minimize surprises
and give time to make pre-year end adjustments
(2x/year)
• Review, design and execute an estate plan
• Review, design, fund, and monitor retirement planning
• Review, analyze, and select cost-effective/proper insurances in
all areas

Greed/Fear

Key Strategies
• Eliminate all undisclosed conflicts of interest
• Have Fee-Only Fiduciary assemble an Expert Team that will
collaborate well and is dedicated to your personal and business
success:
• Comprehensive wealth manager, corporate attorney, estate
planning attorney, CPA, bookkeeper, seasoned insurance agency,
third party custodian for investments

Key Strategies
• Four key areas of focus in years 1-7
1. Manage spending
2. Avoid non-productive debt (debt for toys)
3. Focus on optimizing business / learning the ropes
4. Save and invest aggressively from early on
• Common mistakes
• Overspending: Pent up demand of dentist & spouse IS REAL
• Over-buy on first house

Stage 2: Professional Maturity
Timeline
•Years in Stage: 20-25 years
•Target Ages in Stage: 35-60
•Milestones: Continue with review and monitoring of changing needs in the areas
of personal and business goals. Personal and business budgets and benchmarks. This
stage focuses on building on the Financial Foundation created in Stage 1. Laser focus on
harnessing business cash flow to complete debt payoff of practice, equipment, and
buildings and build personal wealth. Student loans are retired in this Stage. Investment
Wealth will go from $1-8 Million in liquid assets as rigorous funding of the 401k plan/ DB
Plan and annual Taxable Investment Targets are reached. Practice revenue target is 3rd
and 4th Quartile. Ortho Income Target $469K-$1,000K.

Stage 2: Professional Maturity - 35-60
Beginning of phase End of phase
Associate income $180,000 – $300,000 $200,000 – $350,000
Owner income $467,000 – $680,000 $469,000 – $1,000,000
Housing debt $750,000 (home #2) $400,000
Student debt $150,000 (min.) $0
Business debt (start-up) $138,000 (12 yrs 5.5%) $0
Business debt (buy-in) $166,000 (12 yrs 5.5%) $0
Business debt (purchase) $247,000 (12 yrs 5.5%) $0
Business debt (property) $606,000 (7 yrs 5.5%) $0
401k (GP) $53K/year + $18K $59K/year + $18K
Additional savings $50,000 – $120,000/year $120,000/year+

Stage 2: Professional Maturity
Milestones
• Track business cash flow (33% of orthodontists have a written
practice budget*)
• Set annual investment and capital goals to harness cash to
fund preset targets. As debt is paid off and more cash flows
through both the business and personal accounts it
becomes more crucial
• Review, analyze and monitor areas of tax, insurance, estate
planning, retirement projections and investments regularly
* Source: 2015 JCO Orthodontic Practice Study Part 1 Trends, 11/2015

Stage 3: Full Financial Freedom
Timeline
•Years in Stage: 25-35 years
•Target Ages in Stage: 55-90
•Milestones: Wealth Harvesting and Preservation are the Milestones in Stage 3.
Continue with review and monitoring of changing needs in the areas of personal and
business goals. Personal and business budgets and benchmarks. This stage focuses on
preparing the business for sale and maximizing the net after tax amount. The net
proceeds of sale are then invested in the taxable investment accounts. The Investment
portfolio is sizeable and the asset allocation is managed for Wealth Harvesting and
Inflation hedge. Monte Carlo Retirement Modeling is used to regularly back check
probabilities of success in retirement. Downsize house -pay off all debt. Develop
Personal and Family Legacy Goals.

Stage 3: Full Financial Freedom - 55-90
Beginning of Phase Retirement
Associate income $250,000 – $350,000 --
Owner income $469,000 – $1,300,000 --
Housing debt $400,000 Value: $1MM
Student debt $0 $0
Business debt (start-up) $0 Value: $950K – $1,600K
Business debt (buy-in) $0 Value: $950K – $1,600K
Business debt (purchase) $0 Value: $950K – $1,600K
Business debt (property) $0 Value: $750K – $1.5MM
401k (GP) $59K/year + $18K Value: $2.5MM – $4.5MM
Additional savings $85K – $120K annually Value: $2.8MM – $5.5MM

Stage 3: Full Financial Freedom
Key Strategy
• Commercial Property Ownership/Practice Sale
• 50-60% of practitioners own their office/building
• Capital / Debt: $750K to $1.5 million
• Purchase 5+ years into practice. Pay off within 15-20 years
• Rent to buyer of practice for $5-$9K per month
• Practice Revenue of $1,250K = $937,000 Sales price.
• Sales prices range from 0.70 to 1.0 + X gross revenues
• The stronger / more profitable the practice the higher the
multiple.
• Location, stable patients, net income , growth are key to value

A Word on Investments
• Stage 1 – Stage 3: Investments play an increasingly
important role
• Retirement is about spending and monthly cash
flow
• Pillars of full financial freedom:
• Investment accounts
• Commercial real estate
• Practice sale value

Copyright 2016 All rights reserved.
Part 2.
Client Case Studies

Retirement
• Timing: 25 to 35 years in practice
• Annual Spending: $150K to $240K (after tax)
• Housing:
• No debt on house
• Downsize at or in retirement
• Business:
• Sell practice
• Work part-time
• Investments:
• $4 - $10 million in investment assets + commercial property

Retirement Projection #1
Dr. Alfred B. New: Assumptions
• Married, 36 years old, retirement at 65, live to age 90
• Retirement spending: $15K month ($180K annually)
• Save $53K/year plus $18K/ year from age 35 until age 65
• Sell practice for $850K before taxes ($637,500 after taxes)
• 4 year college for 3 kids at $20K per year per child
• Inflation: 3%
• Pre-retirement returns: 8%
• Post-retirement returns: 7%
• Tax Rates 30/28%
• Fat Tails

Monte Carlo Simulation – Case 1

Retirement Projection #1 and #2: Results
Dr. Alfred B. New Results
•Projection #1
• Result in Monte Carlo Simulation: 74% success
rate
•Projection # 2
• To achieve 94% success Dr. New must also save
$50K per year in taxable investment accounts from
now until retirement (29 more years)
Retirement is about monthly spending after work
ends

Save Additional $50K – Case 1

Retirement Projection #1 Case #2
Dr. John R. Mature: Assumptions
• Married, 47 years old, retire at 67, live to age 90
• Retirement spending: $20,000 per month ($240K annually)
• $450K in retirement and wife has $89K
• Saved $53K/year from age 46-65, plus $18K for spouse
• Also saved $15K month ($180K annually) in taxable accounts
• Sell practice for $1,000K before taxes ($740K after taxes)
• 4 year college for 3 kids at $36K per year per child
• Inflation: 3%
• Pre-retirement returns: 8%
• Post-retirement returns: 7%

Monte Carlo Simulation – Case 2

Retirement Projection #2 Results
Dr. John R. Mature Results
• Results in Monte Carlo Simulation 91% success rate
Retirement is about monthly spend after
work ends.

Another Word on Investments
• Investment returns in projections range from 7-8%
• The most sure way to fail in retirement is to let greed
and fear or lack of focus control your investment
strategy.
• We use institutional class mutual funds with
• Very low costs
• Tax efficient management
• Patient long term performance focus

Average Investor Results
20-Year Annualized Returns by Asset Class
(1995 – 2014)
Source: Dimensional Fund Advisors for Dimensional indices (DFA 80/20, DFA 60/40); The S&P data are provided by Standard & Poor's Index Services Group (S&P 500); Barclays indices copyright Barclays 2015 (Bonds); MSCI
data copyright MSCI 2015, all rights reserved (EAFE); Dalbar, Inc. “Quantitative Analysis of Investor Behavior 2015,” www.dalbar.com (Average Investor); US long-term bonds, bills, inflation, and fixed income factor data ©
Stocks, Bonds, Bills, and Inflation Yearbook™, Ibbotson Associates, Chicago (annually updated work by Roger G. Ibbotson and Rex A. Sinquefield). Indices are not available for direct investment; their performance does not
reflect the expenses associated with the management of an actual portfolio. Past performance is not a guarantee of future results.

Cambridge Wealth Counsel
WM=IC + AP + RM
Wealth Mgmt. = Investment Consulting + Advanced Planning + RM
• Investment Consulting—Fee-Only Fiduciary—No Conflicts of
Interest
• Advanced planning
• Wealth enhancement
• Wealth protection
• Wealth transfer
• Charitable gifting
• Relationship management
• Expert team / client relationship management

Ortho - Client Case Study #1
• 15 years in practice, $275K net income per year
• Single, male, early 50’s, Southeast U.S.
• Associate for first 10 years of practice
• Poor location
• Management issues
• Overhead and staff costs too high
• Very average marketing
• Scheduling not optimized

Ortho- Client Case Study #2
• 23 years in practice, $650K income per year
• Married, age 58, West Coast
• Owns building (paid off by retirement date)
• Purchased practice 21 years ago
• Tax optimized:
• 401k $53K + $6K catch up + $24K spouse
• Saves / invests $84K per year in taxable accounts
• Vacation 6 weeks per year (one European vacation)
• Ends work day at 4:30 P.M.—will retire at 62

Ortho- Client Case Study #2
• 11 years in practice, $900K income per year
• Net Income $900K per year – 2015
• Married, age 43, 4 kids, Southwest U.S.
• Business / Marketing undergraduate degree
• Cold start-up; $1M gross revenue by year four
• 401k plan: $53K per year + $18K for spouse
• Purchased $1 million building
• Saves $300K per year.
• Works four days a week
• Will be able to retire at age 60

New Regs for Combo 401K/Cash Balance Plans
IRS Revenue Regulation 2014-41
• Since 2010 historic high degree of uncertainty surrounding such
plans:
• 2 main areas—of historic concern
• Employees covered
• 5 Years of “must fund” commitments
• That has now changed!!!!!!
• New Comparability—40% coverage requirement
• 5 Year Plan Level Commitment
• 2 Year Funding Commitment
• Dial in Contributions (fund/not fund)—Up or Down for
remaining 3 years if constructed correctly.

Cash Balance -Case Study #2 and #3
• Orthodontist/spouse age 53
• Income 875K (W-2 $265K)
• Shareholders Contribution $236,215 (91.27%)
• Staff Cost $22,587 (8.73%)
• Total tax savings 45%($258,802) = $116K
• Orthodontist/spouse age 62
• Income 900K (W-2 $265K)
• Shareholders Contribution $347,835 (93.93%)
• Staff Cost $22,467 (6.07%)
• Total tax savings 45%($370,302) = $166K

Conclusion
• Dental Practice can be both rewarding and challenging.
Working with the right professional team in the right way will
help you move through the 3 Stages of the Ortho Financial
Life-Cycle in the most reasonable way - saving you time,
frustration and money. Strong consistent progress brings peace
of mind and a sense of satisfaction.
• To explore a deeper working relationship with our firm—sign
up for a 1-hour one-on-one meeting for tomorrow between
9am – 3pm.
For other information about our firm visit
www.cwcounsel.com or contact Robert Hockett at
801-783-2241 or robert@cwcounsel.com

Persistence
“Nothing in the world can take the place of
persistence. Talent will not; nothing is more
common than unsuccessful men with talent.
Genius will not; unrewarded genius is almost a
proverb. Education will not; the world is full of
educated derelicts. Persistence and
determination alone are omnipotent.”
– Calvin Coolidge

Disclosures
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certain level of skill or training. CWC may only transact business in those states in which it is notice filed, or qualifies for an exemption or exclusion from notice filing
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Some portions of this publication include the use of forecasting tools. These are intended as informational aids solely for your convenience, and in no way should any
client or prospective client interpret these aids as a method by which investment decisions should be made. We do not guarantee the accuracy of the information
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statements contained herein are forward-looking statements which point to future possibilities. Due to known and unknown risks, other uncertainties and other factors,
actual results may differ materially from the results portrayed in such forward-looking statements. The illustrative results presented regarding the likelihood of various
investment outcomes in the future are hypothetical in nature, do not reflect actual investment results, and are not a guarantee of future results. Illustrative returns
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Performance for composites and indices included in the Average Investor Results are provided for illustrative and educational purposes only. The “Quantitative Analysis
of Investor Behavior 2015” (“QAIB”) measures the effects of investor decisions to buy, sell and switch into and out of mutual funds over short and long term timeframes
and was conducted by an independent third party, Dalbar, Inc., a research firm specializing in financial services. QAIB uses data from the Investment Company Institute
(ICI), Standard & Poor’s, Barclays Capital Index Products and proprietary sources to compare mutual fund investor returns to an appropriate set of benchmarks.
Covering the period from January 1, 1985 to December 31, 2014, the study utilizes mutual fund sales, redemptions and exchanges each month as the measure of investor
behavior. These behaviors reflect the “average investor.” Based on this behavior, the analysis calculates the “average investor return” for various periods. These results
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The performance results for composites shown herein do not reflect the impact that material economic factors could have had on a portfolio manager’s decision-making
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Disclosures
The securities held in clients’ accounts following a particular strategy may differ significantly from the securities included in any benchmark indices shown herein, and
the volatility of the funds may differ significantly from that of the benchmark indices. References to specific indices and composites are presented principally to illustrate
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recommendation to purchase or sell any security. CWC is under no obligation to hold any equity position for any time period and CWC’s current recommendations are
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Sources: Dimensional Fund Advisors for Dimensional Indices (DFA 80/20, DFA 60/40); The S&P data are provided by Standard & Poor’s Index Services Group (S&P
500); Barclays indices copyright Barclays 2015 (Bonds); MSCI data copyright MSCI 2015, all rights reserved (EAFE); Dalbar, Inc. “Quantitative Analysis of Investor
Behavior 2015,” www.dalbar.com (Average Investor); US long-term bonds, bills, inflation, and fixed income factor data © Stocks, Bonds, Bills, and Inflation Yearbook™,
Ibbotson Associates, Chicago (annually updated work by Roger G. Ibbotson and Rex A. Sinquefield).

Copyright 2016 All rights reserved.
Cambridge Wealth
Counsel
Counsel. Plan. Prosper.
Robert Hockett, CFP®
robert@cwcounsel.com
w w w.cambridgewealthcounsel.com
801-783-2241
Off ices in Atlanta and Salt Lake City
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The Financial Life Cycle of the Orthodontist - Utah Association of Orthodontists

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The Financial Life Cycle of the Orthodontist - Utah Association of Orthodontists