HARLEYSVILLE, PA. - By the time you read this, I will be operating in a beautiful new $1.5 million office building complete with two back-to-back dental surgery suites and a small recovery room. I also will have the ability to achieve twice as much throughput as I can in my current facility. But the process of building the facility was anything but efficient. I would caution anyone thinking of building new to expect a mound of red tape, delays and plenty of cost overruns. Here's what happened.

Truly painless dentistry
As a dentist who has also completed an anesthesiology residency, I have a special set of skills that I use to help a special group of patients: Those who need to be put to sleep to face any dental procedure, from fillings to wisdom teeth. Like many dental and dental surgery practices, we do a full gamut of general dentistry and dental surgery, including restorations, root canal, periodontics, surgical gum therapy, wisdom tooth removal and placing dental implants. But unlike most, we do a large percentage of these procedures under general anesthesia. About 70 percent are done with inhalational anesthesia, the rest with IV.

	FACILITY: North Penn Dental Arts, Harleysville, Pa. WEB: www.sedationdentist-philadelphia.com IN SHORT: Despite the red tape, hidden costs and false starts that plagued construction of this two-story dental surgery center, this doctor's dogged determination has paid off handsomely: He now has a palatial place in which to practice and the deed to go with it. Soon, he hopes to have tenants.

I have a dental surgery suite in my current office, which is situated in a small converted colonial-style house that I lease. But it's clearly not helping me meet the demand for the procedures I do. The biggest problem is that there is only one room, and that it functions as our recovery room as well as the surgery suite. Because we are placing the patient under general anesthesia, it takes a while for the patient to wake up - and longer for some patients than others. You can imagine the bottleneck this creates. We finish a procedure and are ready for the next one, but we have to wait until the patient is comfortable enough to walk before we can turn the room over and start the next case.

Back-to-back surgery suites
As I mentioned, my new facility features two surgery rooms. My plan is to help the CRNA put the patient to sleep, do my part of the procedure, allow my specially trained dental assistants (similar to physician assistants) finish and start hooking the next patient up to the monitor as the CRNA brings the last one out of anesthesia. Ultimately, I may hire a second anesthesia provider so that I can move very rapidly from one case to the next.

Our chairs in the room are dental chairs. We purchased a combination wheelchair/stretcher for taking patients from the chair to the recovery room.

We are installing brand new OR monitors that will measure EKG, PO2, capnography and anesthesia gases. We have a BIS monitor for brainwaves. We will place monitors in the recovery room as well.

The cabinetry includes a dental delivery system with all the drills plus a glass-enclosed computer touch screen for medical records.

I estimate the two rooms and the recovery room, with all the equipment, cost about $100,000.

Our sterilization room is set up so that it's easy to tell which instruments are waiting for processing and which have been processed; the former area has a red glowing light and the latter has a blue glowing light.

The inefficient part
Although my office is built for speed, the process of planning and constructing it was anything but.

The first job was arranging financing. My bank liked the project, but there were two surprises. First, I learned that there is a large investment required to negotiate all the red tape prior to breaking ground - a process that I'll explain shortly. My bank refused to finance any of these "soft costs." It did agree to finance the "bricks and mortar" to the tune of 85 percent of the assessed value of the finished building. It turned out that the assessment didn't come in as high as I had expected, forcing me to foot more of the financing than I had planned. One good thing: the bank agreed to let me only pay the interest payments during the construction phase; the principal payments won't kick in until I move in.

Once I secured the financing, I turned my attention to finding an easily accessible site not too far from my current location. After engaging a commercial realtor to help me look, I discovered that I also needed to engage a civil engineer to help me find out whether the sites I liked would be acceptable to the township.

I made offers on two properties on a contingency basis (no deal until my project was approved). My civil engineer drew up simple diagrams and showed them informally to the township supervisors. It was a no-go both times - not enough parking space, the township said.

My break came when CVS had to back out of its plan to build a drive-through 24-hour pharmacy on a two-lot parcel south of my current office. The township approved the pharmacy, but would not grant a variance for the drive-through. The property was expensive, but I thought I could purchase both lots and then sell the second one. Of course, it couldn't be that easy. As it turns out, because the building next door is a residence, I had to have a greater setback from the property line than expected, meaning that I had to use part of the second lot for parking. I was disappointed, but decided to go ahead anyway.

At this point, I engaged an architect to draw up formal plans. One great piece of advice I got was to build as big as I could and rent out the space I wasn't planning to use. So much of the expense of a commercial property lies in the bureaucracy. The cost of actually building more space is minor in comparison.

Once we settled on a plan, the architect prepared a color rendering for me to take to the township. We went back and forth on site items like sewers, lighting and parking, and finally got our preliminary plan approved. After that, we sent the plans off to the state Department of Labor and Industry, which also had to approve them.

The next step was to bid the project out to five builders. We chose the one that had the best references and the most experience with dental-type facilities.

Of course, I had to have my attorney at every township meeting and involved in the real-estate and building contracts. The expenses piled up very quickly.

More construction headaches
Construction started in May, and almost immediately we ran into more challenges.

The sewer lateral coming into the building was five inches too high, meaning that a construction crew had to tear into the state highway to lower the pipe. That project added more than $9,000 to the cost. The soil near the porch of the building was not as dense as we expected, forcing the contractors to dig a deeper footing so that the floor of the porch would not crack.

The inspector for the Department of Labor and Industry informed us that a portion of the sidewalk in back of the building was too steep. The contractors had to break up the concrete and repour it. I'm still waiting to learn how much more that will add to the tab.

I could hardly believe all the fees I had to pay. There were traffic impact fees, based on how many rush-hour trips the business was projected to generate. There were sewer impact fees, parks and recreation fees, and a water use fee. Because of all the additional unplanned expenses and the shortfall on the mortgage, I had to leave two of the rooms in my office unequipped. I plan to revisit these rooms later when we grow into them.

A lasting legacy
At the time of this writing, I'm two weeks away from moving into my new office. I'm still working on leasing the upper floor, which should help significantly with the mortgage.

For the next 20 to 25 years, I will practice in a state-of-the-art facility and I won't have to put up with the hassles of leasing. When I near retirement, I hope to sell my practice but retain the building, derive my income from the lessees and ultimately bequeath it to my child. It's still too early to tell, but it is my hope that this physical structure will have a highly positive impact on my work, my life and my family.