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Howard Farran:
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It is just a huge honor for me today to be podcast interviewing Seth Gibree all the way from Atlanta, Georgia. Seth has been practicing dentistry for more than 15 years, a key opinion leader, an industry expert. He has experience in growth, operations, building relationships, leading change in organizational development. He is currently a supported dentist with Heartland Dental and also serves as their clinical director for the company. By the way man, those guys could've got anybody on earth, and they chose you. That's a hell of a compliment.
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Dr. Gibree's values are rooted in faith, family, community, along with industry and society betterment. He's on the editorial advisor board for Dentaltown Magazine and is actively involved with numerous children's charities. An avid reader and former four-time iron-man, he enjoys sports and is a huge fan of the Boston professional teams and current Superbowl champion, New England Patriots. Dr. Gibree is a husband of almost 19 years. Has two sons. His family's involved in their church missions and fundraising for pediatric cancer organizations.
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Dude, I met you when you were a baby.
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Seth Gibree:
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I know. I was ... Yeah, that ... Dentaltown was huge for me. The whole network of individuals and mentors like you, that have helped my career develop. So, thank you. Namaste, my friend.
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Howard Farran:
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You were saying we were at a Bill Strupp course in Clearwater, Florida?
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Seth Gibree:
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Yep. Back in 2003 or 2004 and a number of townies went and that was the first CE I had really kind of dove into, outside of it. And then from there mentorships and friendships developed and kind of have grown, and it's been a great ride.
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Howard Farran:
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So, which one of the Bill Strupp's courses was that? Was that the real controversial one where he was talking about TMJ was about infection?
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Seth Gibree:
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It was. The bacteria inflamed TMJ, yes. It was really rather interesting.
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Howard Farran:
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And, that was a long time ago. So where did that theory go after that? I mean that was 15 years ago.
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Seth Gibree:
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I don't know if he's still holding on to the theory, but I think everything's somewhat bacterial related. I think as we learn more about the human body, we're learning more and more about its complexity and how everything's interdependent. So, I think there's a component to inflammation that is related to bacteria, and so I can see that side of the argument. But I won't tell a patient that their TMJ is related ... TMJ issues are related to their bacteria loads.
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Howard Farran:
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But you know, whenever it's controversial that we're not ... we don't have all the information. You know, I'd love to ... one of the neatest things I ever did is I got the three books written by G.V. Black, who's the father of modern dentistry, and then they're all a hundred years old. And I read those books and it was so amazing because I was like, "Oh my God, this is crazy." Because they didn't know so many things. So you know a hundred years from now, what percent of what we do is just gonna look silly. And then go back and read a hundred years before him to Pierre Fauchard, the first dentist in France. Go read his book. I mean that was 1800 and at that point it's nonsense.
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Seth Gibree:
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Well, and that's why I think it's so important to continue to learn, because the more you learn, the more you realize you don't know. And I think for somebody to say, "Oh, I know it all," or "I've got this all figured out," then they haven't learned enough yet.
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Howard Farran:
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Oh yeah. And it's so interesting how the more you learn, the more you read, the more you realize you don't know.
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Seth Gibree:
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Oh, absolutely.
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Howard Farran:
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I mean you're so confident in college. You just think you're, you know ... You've got A's in chemistry and physics and algebra, geometry, you're just a master of the Universe, and after you've been out of school for 30 years, you realize, "Man, we just don't know anything."
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Seth Gibree:
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Absolutely. And then your boys realize all of a sudden ... They thought you were dumb and then all of sudden they hit about 25, and realize you were pretty smart.
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Howard Farran:
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Well Ryan, your birthday's next week. How old are you going to be? 23? 24? So, only one more year before you'll think your old man might be smart.
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So I wanted to start with the ... You know, when you got out of school, there wasn't corporate dentistry really, because you'd come out when the first round all ... when there's Orthodontic Centers of America on the New York Stock Exchange and there was a dozen on NASDAQ. They all imploded, went away. They were gone for 10 years and now they're all back and you're the clinical director of the 400 pound gorilla, Rick Workman. How many offices is he up to now?
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Seth Gibree:
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We're about 780 plus, right now.
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Howard Farran:
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780 offices?
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Seth Gibree:
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Yes, that we support.
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Howard Farran:
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Now is that ... Now, supporting, is that different than the one's they own themselves?
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Seth Gibree:
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No. I mean the ownership structure is a little different because it is owned by a state entity. Because you wanna really make sure that the doctor's are making the decisions that's in the best interest of the patient. So the doctor-patient relationship is a local level relationship. Heartland owns the hard assets. Building, chairs, those kind of things.
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Howard Farran:
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They only own 780? I thought they were at like 1500.
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Seth Gibree:
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No, we have about 1400 in chain dentists, 1500 dentists.
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Howard Farran:
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Okay, so 780 locations.
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Seth Gibree:
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Correct.
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Howard Farran:
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With how many dentists?
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Seth Gibree:
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About 1400.
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Howard Farran:
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And how many hygienist?
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Seth Gibree:
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Great question. It's almost 3,000. 27, 2800. So it's about two and a half per doc, give or take.
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Howard Farran:
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And I always tell these ... You know when I was young, it was totally respectable to go into the Army, Navy, Air Force, Marine, Public Health, any health service and get some clinical skills. And I tell these kids, "My God, if you getting a job at Heartland, and they've got the management to run 780 offices, how could you not learn the business of dentistry working for someone that owns 780 offices as opposed to your family dentist from church whose taking on associates that's only ran one office for 30-40 years." I mean you've got to. ... I mean, just think of what they could learn. They could get a dental MBA just working for a year there.
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Seth Gibree:
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Well, I mean, when you had your dental MBA back in the day and had the series and that was one way that I learned, but I also seeked out Rick Workman and others through Dentaltown originally, to try to find out that exact point. So why would I reinvent the wheel when I started my offices from scratch rather than implement systems that were already established in a couple hundred offices at the time? So, back in the day, Heartland used to have a consultant group that they had and you could hire any number of us that were townies, hire them for consulting. And you know what, learn from them. Again, not reinventing the wheel, but just replicating what success they've already had.
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Howard Farran:
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Do they still have that?
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Seth Gibree:
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They do not. No, they're too busy with an internal focus now.
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Howard Farran:
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So, who's really the brains behind Heartland? Is it Rick Workman or is it Pat Bower? Be honest.
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Seth Gibree:
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Honestly, both of them. They're both great individuals, great guys that are trying to do the right thing for the right reason. Now, is anybody perfect? No, and we're the same way. We've got ... Everybody's got their faults and warts and things that they're working on to get better at, but they make a great combination. I mean, of course, Dr. Workman was the inspiration behind the company originally, but Pat was such a big entity when he came in to really help drive the company forward too. So [crosstalk 00:07:16]
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Howard Farran:
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You know, I podcasted Rick and now you. Will you tell Pat I want him to come on the show?
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Seth Gibree:
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I'd be happy to.
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Howard Farran:
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Yeah, and when you say nobody's perfect, my ex-wife says I was perfect.
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Seth Gibree:
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Now, in retrospect.
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Howard Farran:
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She says she left me for imperfect reasons. No, I'm just kidding. So, what could ... Well, two things I want to talk about first. I mean, we can talk about anywhere you wanna go, but this is May 25th, so when do all the dental schools graduate?
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Seth Gibree:
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Coming up soon, like this past week.
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Howard Farran:
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Yeah, so podcasters are generally young. Old farts like me read books. In fact, Ryan, hand me that book there. You know, when I want to learn ... The end one ... I just can't tell you how much I love this book. This was like ... I mean, who ... I mean, Stephen Cohen's Pathways of the Pulp. And it was a short read. It was only 882 pages, but you know, I just ... And what's so cool, Seth, I had this book in dental school.
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Seth Gibree:
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Uh-huh (affirmative)
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Howard Farran:
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And now 30 years later, they're still updating it and I podcasted him. But ... It's the millennials chewing up podcasts.
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Seth Gibree:
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Sure.
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Howard Farran:
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So they're all commuting to work right now. About 20% of these podcasters say they sit in Dental School class with their headphones on, listening to podcasts during boring instructors, or when it's a waste of time, or whatever.
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Seth Gibree:
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Some real world dentistry.
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Howard Farran:
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Yeah. Talk to them about whether or not you think they should apply to Heartland. I'm sure Rick Workman and Pat Bower would appreciate that. And then number two, let's say that they're ... What percent of the class wants to work for corporate forever, and what percent of the class just wants to get experience and a job and learn how to do fillings, crowns, and root canals and quadruple their dental school requirements, and what could they also learn at Heartland?
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So first start with, you're connected to the dental students a lot, what percent ... Because we hear all these mixed things. We hear some say that the soccer moms just want to do dentistry and a five o'clock leave and go be a soccer mom. They don't want to deal with all the business. What percent of the dental students are like that, or what percent of dental students say, "No, at the end of the day, down the road, I'm gonna own my own farm, my own ranch, my own dental office."
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Seth Gibree:
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I think it's hard. So, there's so many things that you bring up with that, and you didn't even touch on dental school debt load these days. And I'm sure we'll get there too.
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So, my situation was, graduating in 2001, not having a ton of debt, not that 250, 350, 400,000 dollars that some of these students are graduating with now. It changes your choices on what you can do going into the marketplace. So I mean, we had classmates right out of school, buy an office, not know they're doing, go to rural Alabama, and succeed. And, nowadays, people want to live in cities, where there's more dentists, you know that. If you want to be successful, go to rural America, where there aren't any dentists and you're the one stop shop, and you're gonna have better success quicker. And so each person's situation is so different within school. So, it's hard to say there's a hard number that are gonna be their own doc.
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Now, I was an associate for people and then I decided to open an office from scratch, and then I opened a second office from scratch before I affiliated with Heartland, about six and a half years ago. And through that process, being able to see, kind of all sides of it, you see what the options that exist for it. And so, my encouragement ... And I talk to dental students all the time. And, my encouragement for them is to find the best situation for them. And everybody's situation is different. What they want. What they need. How they're gonna learn. For some people, that might be going into dental school, planning to go into the military, going into the Air Force, so they can shorten their debt load. And if it were me these days going into dental school, I would really look at going into something like the Air Force to have my dental school paid for, owe them a few years after, and then go do dentistry. And so, it's a matter of what's best for them.
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Now, I know one thing for me, is after my affiliation and I sold my practices. One of the big things for me is that work-life balance. Like, I didn't have that beforehand. And so, being able to do an Ironman the first year after I affiliated with Heartland was a great thing because I had more time. I was working in the practice 35 plus hours a week and then working on the practice another 30 hours a week outside of it. So I had ... I tell students I had separate jobs. I was a dentist, and then I was a practice owner. And I got paid for both, but the stress load of being a practice owner was more for me. I was more overweight. I was not in good shape physically. Just, I don't know, time catches up with you. And so, figuring out what situation works best for them.
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What I like about what we have to offer, and what a number of the other DSOs have to offer, is the ability to kind of come in, learn, build your skills, build your confidence. And what's nice, the ones that get it and have success in the DSO model, will stay a long time, because they understand that at five o'clock, they can go home. And at five o'clock, when I was an owner trying to go home, I'm trying to figure out how I'm gonna make payroll, why Susie's mad at Jane for something she said, and having to mitigate that relationship and not having the resources that I have now.
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Howard Farran:
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Well said. The life balance. So, how old are your two sons now?
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Seth Gibree:
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They are 13 and 10.
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Howard Farran:
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Oh my God. I can remember ...
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Seth Gibree:
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They keep growing up.
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Howard Farran:
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Oh my gosh, I can remember when they were just born. So, when these kids come out of school, why should they work for Heartland.
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Seth Gibree:
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Well, I mean, again, like you said, we have the best resources available. We have systems. We'll have 300, 400 plus new doctors come into the company this year. That, as things expand and grow, that we're working toward a training platform. We have doctor ment- ... We have something called a DMP, which is a way for them to help with some of their debt load coming out of school, but also help to grow them quicker.
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I know one of the best things for me was having a mentor network. That was why Heartland was so valuable for me. It's because, you go to dental school and you're with all these people, then you get out and start practicing and you're with three people and you don't get to talk to anybody or you're ... It's ... You're on an island. I remember you always saying that it was like practicing on an island.
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And then so, having others that you are able to relate to and connect to really helped me and part of the mentorship was there. And so I think that's the big thing of what we have to offer is being doctor led, having that clinical decision making, be the doctors decision for the patient on the local level, but having resources and an education platform where ...
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[inaudible 00:14:09] something right now, where we're trying to get people to achieve fellowship in the AGD. So, a pathway to achieve fellowship, to build your clinical skills, to shorten your learning curve so you can have greater success over time. And so that was one of the big things for me, with mentors, with Dentaltown, that now I see with heartland is ... You know what, somebody can send out an email on a case they're looking at and get 500 other opinions from dentists in a non-judgemental way, because sometimes on Dentaltown, we get judgemental responses, and it's like ... It's that altruistic side of everyone trying to help one another to get better.
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Howard Farran:
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We started that Dentaltown mentorship program this year. And I didn't know if it'd be a big success or not and it was a huge success. Did you see that on Dentaltown.
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Seth Gibree:
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I did.
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Howard Farran:
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Yeah. You said it was a DMP. What does DMP stand for?
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Seth Gibree:
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Doctor Mastery Program.
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Howard Farran:
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Doctor Mastery Program. And you said that it helps with debt. What are the details? What do you mean? How does it help with the debt.
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Seth Gibree:
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So it's a five year ...
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Howard Farran:
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And furthermore, of those three to 400 new dentists who join Heartland, how many of these will be kids straight out of school versus someone older and wanting to affiliate.
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Seth Gibree:
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About three quarters of those will be within the first couple of years of graduation.
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Howard Farran:
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And, you know, I gotta say something that's so cool about Rick. I do. I love Rick. I mean I've flown out to [inaudible 00:15:35], I just love the guy. He is such a good guy. But a lot of these dentists that have complained about DSO's. You call them DSO's or DMSO's?
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Seth Gibree:
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I call them DSO's. Dental Service Organization, but you can call them either way.
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Howard Farran:
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It seems like Wall Street calls them DMSO's and in the trade we call them DSO's. But on these dental service organization. You know, those kids that ... All the dentists complaining at corporate. It's because they don't like any competition. I mean every Fortune 500 company, CEO grows up believing in free trade, then as soon as they got a Fortune 500 company, they're now in Washington DC trying to restrict trade.
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But number two, all these dentists on, they don't provide jobs. And here's Rick, hiring them, three-quarters of them straight out of school, no experience. And you look on the classified ads on Dentaltown, which we're adding to the app next month, that classified ads program is an amazing place to find dentists. Almost every ad a dentist writes, they want five years experience.
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Seth Gibree:
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Exactly.
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Howard Farran:
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Well, where the hell can you get five years experience? So, kudos to you guys for providing jobs to our sovereign professional colleagues who just graduated negative one week ago.
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Seth Gibree:
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Exactly. But it's how do you set them up for success? And I think that's key. And I think that's hard why a doctor is looking for five plus years of experience is because they don't wanna invest the time, that someone invest in me like you did, or Rick Workman invested in me, and many others ... To learn what we need to learn or to have guidance. Or, to be able to reach out and call somebody. And I think having those resources ... And commend you guys for starting the mentor program at Dentaltown, but to have those resources are so important. If somebody doesn't want to take the time that it takes to really invest and learn. It's hard when you're owning a practice and you're so busy and you're trying to manage it to really help guide somebody's career. I mean, and that's what you are doing when they first get out.
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Howard Farran:
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But more specific, you said you help with their debt load.
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Seth Gibree:
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Sure.
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Howard Farran:
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What does that mean?
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Seth Gibree:
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So, part of the Doctor Mastery Program, it's a five year program and really what the goal is, is that they have a fellowship in the AGD at the end of it, based on hours and being able to pass the AGD test. But there's bonus opportunity that they can earn up to 250,000 bonus that will actually help work with their debt load too.
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Howard Farran:
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So at the end of the five years, if they work for you for five years and get their FAGD, you guys will kick in 250,000 towards their debt?
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Seth Gibree:
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Potentially. It depends. There are some other requirements that go along with it, some practice related perimeters, making sure there's some community service related to it, patient care experience. So, it really goes to creating leaders for the office and creating complete professionals. So, it's not just your dental skills. It's actually some of those soft skills too, that really where ... I got a friend of mine who's a dentist, who says, "Our job has little to do with teeth." And, that's so true and that's where I think we miss the boat a lot of times because we get so caught up in the technical and we don't really understand how to talk to people.
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Howard Farran:
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Oh my God. All the dentists who are crushing it. Everybody doing a million, it's because they get an A on the personality, the soft skills, the communication, the staff leadership and they might be the worst dentist on Earth. And then some of the best Pankey Institute dentists who've mastered [inaudible 00:19:06] and Spear and all that stuff. They just bumble along because they can't talk, or they talk down, or they talk condescending, or etc.
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I imagine in the private sector with associates and in the corporate sector, the hardest thing is keeping associates. When people say, "Well these places have high turn over of associates." Well, so does the private sector. I mean everybody I know, it's considered almost a miracle if some kid stays with five, six, seven years. But eventually, they all ... At the end of the day, they all leave and go set up their own, unless you're hiring the backend of the tail, where they've already done it for 25 years, 30 years and they're done with that, burned out of that and just want a job. But if you get them when they're young the associate turn over is very high. So, I imagine this was all put in place to try to keep people for five years. I mean if you could keep your average dental student out of school for five years, that would just be the most valuable thing they could do. Correct?
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Seth Gibree:
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Well, I mean the other things is, is too. Once somebody achieves success in the model ... So, we don't have turn over on our top 50% of the docs. It's our low performing docs that are the ones that turn over, that don't really dive in to feeling like they have ownership of the practice, or don't really embrace the need to grow and to change and to learn. Those are the ones that you see turn over in.
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In regards to our top performing doctors, it's like once they understand that they can be a dentist, and that's their focus, be nice to people and treat them right, and be a dentist, we don't have turn over in there. And so, it's cool to see and it's cool to be able to look at it with perspective. But, it's hard to convince people that sometimes that really once you help people to achieve success and to achieve a comfortable lifestyle and get in a good place for them, work-life balance ...
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I mean we have a doctor right now, she's awesome. She's just a couple years out of school. She was working in Tampa. Her husband got transferred to Colorado. Well, she's going up to Colorado, still working for us, opening up an office for us up there. Because she loves where she's at, the success that she's had and realizes that she can also achieve balance with it. So with our top docs, we don't have the turn over. It's usually in that lower tier. And it's usually in the first 12-18 months of the relationship.
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Howard Farran:
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Yeah. You know, growing up with five sisters, I saw the massive inequality of men and women. My mom would let me swim in the Arkansas River, which was like a hundred yards from our house, but my sisters couldn't go within 10 feet of the edge. I was put in blue jeans where she ironed patches on the knees and then they're put in dresses and got in trouble if they soiled their dress. I mean, it was just crazy and I have had, locally here, a few girls in my house, melting down bawling because she started a practice, built it up, and was doing like 800, 850. She was making 250. Her husband was making 60 grand and he got transferred and he's like, "You know, I'm going." And she's like, "How do you ..."
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You know, it's just so sad and these women ... You go around the world, I mean how many countries can they not even drive a car in. And it's tough when you are a women married to some male walnut brain who makes half the money you do, but he's the man. He's the 400 pound gorilla and he's gonna chase his military promotions, his corporate promotions. And so girls, a lot of girls, depending on who they marry, they need liquidity. They need to be able to transfer from East Coast to West Coast. I mean, so I can see how that would do that.
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Seth Gibree:
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Well, and a lot of people now just want that. I mean millennials by nature, that's something that they want too, is they want to be able to move. And it's not the find a location and work there in the mill for 30 years anymore. It's totally changed. So they want to go from one place to the other and work here for a few years and then maybe they want to move to Vermont and got work there for a few years.
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Howard Farran:
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Well there's also the other issue. The marriage issue. I mean, at the end of World War II everyone was getting married at 16, 17 years old.
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Seth Gibree:
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Not now.
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Howard Farran:
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Now it's close to 26, 27. And, I have met several dentists, both male and female that started their own office, they were single. Then, they met the love of their life and they're in another state and that person's not gonna move for various reasons or whatever, family, whatever. And, they're like, "Damn. So what do I love more? My office that's four years old, that I built in Chicago? Or this beautiful woman in Charlotte?" And so there's a lot of variables on this practice deal.
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Seth Gibree:
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There's a lot of variables on marriage too.
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Howard Farran:
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Yeah. Yeah. It is ... It's the best decision I ever made. I mean, I got Eric, Greg, Ryan, and Zach. I mean, I just never see my magnum opus as being a dentist or Dentaltown or any of that stuff then. That's stuff's always been ... Dentistry has always been my career ...
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Seth Gibree:
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Procreation.
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Howard Farran:
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My four boys have always been my profession.
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Seth Gibree:
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Absolutely.
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Howard Farran:
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And I want to tell you a head's up on yours. This time, when they're 10 and 13 you think, "Ah man, it's the best ever." And then they're gonna grow up and get a car. It actually gets better every year.
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Seth Gibree:
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Huh. That's good to hear. Because it's pretty great ...
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Howard Farran:
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You will love them more at 23 and 20 than you do now. I used to be so sad when they kept getting older. I go, "It's going too fast," but it just keeps getting better and better and better.
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So, what practice management things have you learned watching Heartland, that all my homies listening too you that just own their own place, what business practice management from a group that owns 780 locations could be applied to sole practice? And I think you should write that article. I do. I think you should write an article in Dentaltown Magazine that says "I own my own practice. I own two practices. Now, I am with the biggest dog on the block that owns, basically, 800 offices with 1400 dentists." Lessons learned that you can apply to the solo practicing office. Wouldn't that be a killer article?
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Seth Gibree:
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Yeah, and I'd be happy to write that. So, have them send me over information and we'll get it done.
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I think the biggest thing, and this is gonna sound stupid, is really systems. Making sure that you have good systems in place from when somebody enters the office, till when they leave, and what your follow up is after that. And so really systematize and dial down and ... I think we try to over complicate things. We always want the shiny chicken, we want the shiny new toy, that ends up in some closet somewhere gathering dust, rather than focusing on patients.
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So, I think that the two main things that I would say is really dial in your systems and know your basics, what your flow is through the office, and be nice. If you can be nice to people, if you can smile and relate to them and you have those soft skills and can communicate with them, then you will be successful. But people have to feel cared for.
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And even now-a-days, the expectations get higher and higher and higher, because all of sudden they're gonna go on Google and read a review or say a review. And you know that somebody that has a great experience isn't necessarily going to say anything, and that somebody's got a negative experience is gonna dog you out. And so, how do you really relate to people in a way that they feel cared for and to truly mean it? And so, it's a gift to have, but those are the basics behind it. Is really not ... Don't sweat the small stuff. Having systems in place so that people know their jobs. They know the expectations. They know what's expected of them, because when people know what's expected of them, then they're more apt to succeed.
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I was reading a thread on Dentaltown last night that was talking about ... They had diagnosed somebody needing two fillings and they weren't sure whether their front office would talk to them about it or not. And that for me is such a basic thing, that she just doesn't know that's an expectation of her. And so, making sure that there's expectations and there's systems related to how things flow.
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Howard Farran:
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The dentist diagnosed two cavities and he was not sure about what?
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Seth Gibree:
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Whether his front desk was gonna talk to the patient about them and if the patient was gonna reschedule about it. It's that whole, you tell somebody they need something and then you leave the room and you kinda peek your head around the hall just waiting to see if that patient says yes or not.
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And they just didn't have a system in place on how they're going over treatment with a patient. And so, just really systematizing down your operations so that you can practice dentistry and not have as much stress related to it, where there's so much ambiguity.
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I think from a team member success standpoint, they have to know what's expected of them otherwise they're gonna stray and they don't understand. It's not like they do it on purpose. I haven't met anybody that said, "I'm gonna go mess with my local dental office." Or, "I haven't met an employee that's not angry." Don't get me wrong, when they get bitter, that's a whole different game. But, I haven't met an employee that wants to work at a location that is trying to purposefully do something wrong. And I think sometimes, we take things personal, but it's not. It's that they just don't know what's expected of them.
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Howard Farran:
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Well, I think it's hilarious when you look at half those threads on Dentaltown where they really think being the best dentist in the world is the right implant, the right bone graft, the right composite bonding, rubber dam, all this stuff, but when you go those offices when you look at the microeconomic data, for every hundred cavities diagnosed, only 38% are done.
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So, when you only fix one cavity out of three ... I don't care how you fix that one out of three, you're a horrible dentist. And then you go look at other dentists in the same medical dental building and there's a different person who has these treatment plan presentations, financial arrangements, treatment coordinator, and they do two out of three. And I'm convinced, after 30 years of watching this game, that one out of three, that walk into a mall, a store, a dental office, a car lot, they're never gonna buy for anything in the world.
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Seth Gibree:
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Sure.
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Howard Farran:
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They're just ... Because monkeys are crazy. And, they're not gonna do it. But, the difference between the person who gets the treatment plan presentation, financial arrangement right, and gets two out of three of their patients to get a cavity done is far better than a dentist ... In fact, I've always said that we'd all be better dentists if we all removed all of the decay and just pack the damn teeth with butter. You know what I mean? I mean, I'd rather have butter fillings and get all the disease out of the mouth, than the best composites in the world while they're still at biofilm. I see it all the time, they'll do an MOD on the molar and the bicuspid in front of it still has [inaudible 00:29:57] but the patient only want to do one. I mean, why can't you convince them of the biofilm that you can't put out a house that's on fire when the one next door's on fire. I mean, that fire and biofilming are gonna spread ...
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I want to lead to another question. So, you got 1400 doctors. You say that you have low turn over in the top 700 higher producers. What return on investment have you seen from these high ticket items? Because some of these items are expensive. CBCT's, Cad cams, lasers, digital scanning impressions. Do you guys see that any of these are ... You know, you put them in an office and it's a definite return on investment?
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Seth Gibree:
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Well, I think that's where educating the doctor on the relationship is. Because the doctor is ultimately the leader of our practices. And so, having a conversation, if we are gonna get a CBCT print, if the office is gonna invest in a CBCT, it has to make sense. And I think for some offices, it does make sense. For the doc putting in 30 implants a month or 20 implants a month, having a CBC makes sense. For the doctor who's doing three implants a year because they took some course that they loved and they were like, "Oh yeah, I'm gonna do a ton of implants," and they're not doing it, it doesn't make sense.
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Now, I do think something like scanners does make sense because digital dentistry is coming. It's here. It's been here for years. I mean, we've seen the changes in CEREC over the years. We've seen things like Trios that come out now. iTero scanners, Care Streaming, I mean, there's so many people in that industry now and in that market place.
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And, in the way the lab industry has changed over the years, that ... I mean you can take a scan and send it anywhere and still get an FDA cleared grade crown dialed in at a reasonable price. So, I think that scanners are a big future. You look at things like Invisalign. Invisalign's technology now versus what it was eight years ago is completely different. I remember when I first started doing Invisalign, it wasn't completely predictable. And now, I feel like with Invisalign, I can provide a great service and a great result, and people are getting what they want and what they need. And so I think that ...
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Howard Farran:
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Which scanner did they buy? Invisalign, who do they buy?
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Seth Gibree:
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Invisalign is an iTero.
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Howard Farran:
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iTero?
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Seth Gibree:
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Yep.
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Howard Farran:
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Yeah. So, when you said a CBCT makes sense if you're doing 20-30 implants a month and obviously doesn't make sense if you are doing three a year, but 20-30 is a big spread. I always have been telling dentists that you shouldn't do any procedure that you don't do once a week. I mean, if I had to get a vasectomy, and I had two docs. One said I do it every Friday and the other guy said, "I do it three times a year." I just don't think ... If you don't make a denture, a molar endo, and Invisalign, if you don't do it weekly, the team never gets fast, efficient. And then you come up to the case like "Oh, we're doing an implant again. Let's have a team huddle again and try to figure this out again." But ...
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Seth Gibree:
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It's [crosstalk 00:32:57]
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Howard Farran:
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20 to 30 is a big spread. That's a 50% spread. What do you think they have to actually do a month for a CBC to make sense.
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Seth Gibree:
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Well, I think it depends on what your payment is and what you're getting it at. So you'd have to look at the economics of the deal. But I really think 10 a month is a reasonable number. And again, it depends on your fee schedule and it depends on your overhead. So there's always so many factors. So, it's not a cut and dry situation, but you need to evaluate the parameters of what you're looking at and what you're using it for. And I mean ...
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Howard Farran:
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And I know you have some amazing in house implant training. I have friends that work for you in Iowa that became implant masters. You know who I'm talking about?
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Seth Gibree:
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Who? Ben and Eric?
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Howard Farran:
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Oh my God. I'd have to go to my phone, but some of them ... I mean, you guys really have a lot of in house continued education.
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Seth Gibree:
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Well ...
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Howard Farran:
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So ... Go ahead.
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Seth Gibree:
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No, I was gonna say, education is key. But it's about how many educate ... How many items, like a course on bacterial loaded TMJ do you take and not understand how you implement it. And I think that's one thing. I was a CE junky, even pre Heartland. I got my FAGD really early. I was ready. At that time, you had to wait five years to get your fellowship. I had my hours done in three. I averaged over a hundred hours every year. But I've taken so much CE over the years that I took and then the most valuable part of the CE was sitting around for drinks at night, writing on cocktail napkins in a bar, because I was with other dentists that I took lessons from. But the CE itself, wasn't valuable.
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And so, it's about figuring out what's valuable and then how you can implement it and use it moving forward. Because we like to take things and not implement them. You go back to your office and your teams like, "Okay, just wait them two weeks. We'll wear him down. In three, we'll be back to doing it the way we did it all along." And so that used to frustrate me to no end. And so, it's so important that what you take, you figure out how to make it valuable and how to not waste your time. I mean, that's ... I read all these books like ... I mean, this is the one that I'm reading now. I don't know if you've ... Tools for Titans by Tim Ferris.
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Howard Farran:
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I already read it. It's on my shelf.
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Seth Gibree:
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Yeah. Yeah, it's an ongoing process because of so many different valuable things in there, but ... But what are we investing our time in, that's a commodity that we can't get back. And so, making sure that what we're doing, we're then taking and moving forward, rather than just sitting on it.
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Howard Farran:
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And that's been my mission a long time on Dentaltown and we sell the online CE, In 2004. We're up to 411 courses. And that's really my goal on these podcasts, because all these people that don't have time, they're married, they're kids, they're in rural, their study club meets one time a month, and it's just somebody just lecturing from that little, small town and then here I'm delivering them people like you and Mish, and Christian and every day ...
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Cause after my 30 years, I totally think the number one correlater, is first you're the person. Are they humble? Will they listen to others, the staff, the patients? Are they hungry? Do they have a work ethic? I've always made the joke that's completely true, that the Mormon kid, he graduates with two kids, is ten times more hungry than the kid whose dad paid for his dental school. I mean, just no ifs ands or buts. It's a three to one difference.
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And then there's that thing, that I believe you are born with, that intellectual curiosity. Some people, you ask them a question and they go, "I don't ... I don't know," and that's the end of it. Other people just can't get out of their mind. They always got something ... They're always curious. And like Edison said, he said he figured out 10,000 ways a light bulb wouldn't work. But he still got the damn thing.
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Seth Gibree:
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Well, that how you ... Well, that's how you fail forward. I mean, you make mistakes, learn from that mistake and so something again. There's a great book by John Maxwell called Failing Forward and that's the premise behind it, is you learn what not to do the next time. And I got a doctor that I'm working with right now. She's fresh out of school. She's two months out. She's kicking butt, but she is, what you said. She is intellectually curious. She's inquisitive. She asks questions. She's not afraid to ask. She's not afraid to try things. She's not afraid to move forward. If she's wrong, she admits it. And so seeing somebody that does have drive, yet is humble is ... I mean those are key principles that you can help, hopefully coach that into somebody at some point, but some people just have it. Like you said, it's that innate curiosity that they have.
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Howard Farran:
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Yeah. So, back to digital scanners. So, in your basically 800 locations, how many of them have you put a digital scanner in and what brands did you go with?
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Seth Gibree:
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So, in the last year alone ... Within the last, actually six months alone, we put over a hundred in various offices. That's just over the last six or eight months.
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Howard Farran:
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And what brand?
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Seth Gibree:
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iTero and Trios are the top two. iTero is the highest percentage of them.
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Howard Farran:
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And where is iTero out of?
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Seth Gibree:
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That's Invisalign. Align technology.
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Howard Farran:
|
Oh. So you're putting them in so you can do Invisalign. But is that scanner also doing crown and bridge?
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Seth Gibree:
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It does. Yeah. Crown and bridge and it's also available to do simulation print Invisalign too. So somebody can scan an arch. You can have a patient come in and scan an arch and then push a button and it'll simulate what their Invisalign oral treatment will look like after too. iTero has some really cool stuff in their technology. So those are kind of the [crosstalk 00:38:25]
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Howard Farran:
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Now does Trios do full arch and hook up with someone making clear aligners?
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Seth Gibree:
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They do. Yep. Trios and Invisalign also have a relationship, so you can scan ... Most any scanner you can actually scan then send it to Invisalign to facilitate.
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Howard Farran:
|
So what does the iTero scanner costing and what's the Trios scanner. Trios is out of Copenhagen, Denmark, right?
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Seth Gibree:
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Yeah. I'm not sure what the current cost structure is on them. To depends on your rep, and what the deal is they're able to do for you.
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Howard Farran:
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But so, you're iTero was the majority of your hundred and then Trios was the rest. So, you didn't go with any Carestreams. What's the ... Or 3M's True Definition?
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Seth Gibree:
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No, and those are both good scanners, but for us, it just ... The other ones made the most sense.
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Howard Farran:
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And, what's the ... Yeah. So, True Definition is the smallest one. So, it fits in the mouth of the best but you still have to use the powder I think that's the ...
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Seth Gibree:
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Well if you look at the meeting they just had in Germany at IBS, Trios just came out with a wireless scanner. So there's so much technology. And I mean how many ... You walk around a trade show these days, which are slowly dying, but you walk around a trade show and they're all 3D printers and scanners.
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Howard Farran:
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So why did you just say that you think these meetings are dying?
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Seth Gibree:
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I don't know. Because like podcasts, you have the ability to listen to hundreds of different clinicians from the comfort of your own home and I think the way typical dental meetings are done are different. I mean, back when I was ... [crosstalk 00:40:06]
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Howard Farran:
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You tell Rick Workman that he may have 780 locations, but I now have 780 podcasts.
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Seth Gibree:
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Yeah, there you go. But I mean, you walk a trade show and then somebody tries to sell you something there. But, now you go online. You look. You do the research. You get behind it. It's a different game. So I don't know what the return is for the vendors. Yeah, you'll still have the big ones, but I don't think you'll see as many of the little shows that used to be ... All the state shows that we used to have.
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Howard Farran:
|
Oh it's a ... Well, number one. The biggest problem with the meetings is like Dentaltown Online CE and podcasts, and digital, and YouTube. I mean, I know dentists up the street from me that totally became implant masters on YouTube. Just every night, they'd go home one their iPhone and go to YouTube and search dental implants and watch videos for an hour.
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Seth Gibree:
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I had a friend that did a sinus lift. I said, "Oh, He did his first one." And I said, "Oh, how'd you learn how to do it?" He said, "I went on You Tube and watched." I said, "You went on YouTube and then you just went and did it?" He said, "Yeah."
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Howard Farran:
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And my friend, Chip Castene, he's my age, we both got out of UMKC in '87. He texted me this morning, in the middle of the night, he's in France with Tatum Hill, learning how to do sinus lifts, but that's the difference. He's an old guy so he flies from Bakersfield to Paris, when the younger people would find Tatum Hill on YouTube and watch it in their front room without their shoes and socks on.
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Seth Gibree:
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Absolutely. And then go try it.
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Howard Farran:
|
So, I want to stay on technology though because these are big questions. Of your 800 locations, how many of them have a laser and what's your thoughts on that?
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Seth Gibree:
|
A high number of them. The ... Trying to think, which ones I have. I have a BIOLASE and a Sirona and I actually have a ... From back before I was a Heartland affiliate I had an MDI [inaudible 00:41:55]. So, I think again, I mean we had electrosurgery back in the day.
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Howard Farran:
|
Hah. I can still smell the smoke.
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Seth Gibree:
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Oh yeah. It was great. Just make sure you suction that right there because it's gonna ... You're gonna smell a little bit here today.
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Howard Farran:
|
Oh my God.
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Seth Gibree:
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But I mean ... But now with the cost ... I mean, it's so cost effective. There are some great ones out there. Ultradents. Gemini's great. Sirona's is great. Viola. I mean there's so many great lasers out there now-a-days. And it's so ....
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Howard Farran:
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Well, you know, the cheap ... The low cost diodes. I mean, AMD, Adam Miller's took all the cost out of those things. I'm surprised you don't find one in the bottom of your Peanut Butter Captain Crunch. But, I'm talking about the high end for removing a hard tissue, because I've podcast about three pediatric dentists. They say, "You know, we used to numb. The kid didn't like the shot. We had to let it soak in for 6-7 minutes." The hard tissue laser, now there's no numbing and we're just going in there and by the time it would have been numb, we're done. Are you seeing that, or do you still think that's bleeding edge technology, not really leading edge technology?
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Seth Gibree:
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I think it works in some specialty locations. I think what we typically look at is what's gonna work, kind of across the spectrum. So, I think that there's a place for those things, but some of them aren't necessarily cost effective either.
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And so, in some people's hands a ... I mean back in the day a water lace worked really good or Selaya works really good for them in their situation where they're at. I know for me, in practice, I'm going from this op, to this op, to this op and I'm very busy and structured that, I can numb somebody up, go do two hygiene checks, come back prep it, and then be on and move on to the next thing. So, adding in a piece of technology into my work flow, doesn't necessarily make sense in that situation. But where a low cost diode makes sense, hey somebody comes in for a frenectomy or we're doing a crown prep that's on the distal of 31 and it really needs tissue moved out of the way, then that's ... I mean, for coagulation and for getting a good impression, that works great.
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Howard Farran:
|
Yeah. Great, great point. Okay, now the last big one. CAD/CAM. I mean a E4D or a Sirona, Dentsply, Cerec, I mean, you're talking about a $140,000 bucks.
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Seth Gibree:
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You are.
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Howard Farran:
|
So out of the 800 locations, how many of them got a Cerec and what's your thoughts on that investment?
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Seth Gibree:
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I mean, I think the technology's good, and the fact that they challenge each other is good. I was a Cerec owner and trainer before I was at Heartland supported office. So, I got way back in regards to the Cerec days. So, I think the technology's there to work it well, but, man, I think for me what changed was ... And now you can mill zirconia crowns and do same day dentistry with zirconia. Zirconia was a big change for me because I could prep, temp, have somebody in and out in 40 minutes and then conventionally cement it with a RMGI and I'm getting ... Knock on wood, I have never had a full zirconia break on me. And this is eight or ten years later now.
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So, we're talking eight years down the road, I can have somebody out in 40 minutes or I was the type of the person that I couldn't relinquish control of my Cerec. I wanted to design. I wanted to be a lab tech. I wanted to mill. I wanted to control all that.
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So, I think if you're somebody that can give up all the control, then it can make sense, if it's replicating your lab bill. I think, again, it goes back to the individual office and the situation. They've got to figure out what's right for them. But when I can get a good, a great zirconia crown at a great price and I know I'm giving a patient a long term solution that works, that was one of my big switches for me personally as a clinician, of why it wasn't a ... Why I moved away from CAD/CAM.
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Howard Farran:
|
So, your 1400 doctors in 780 locations, do you guys all use the same lab?
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Seth Gibree:
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So, that's ... I think that might be the difference between us and some of the other DSO's, is that doctors have choices.
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Howard Farran:
|
Ding. Ding. Ding. Ding. Ding. Ding. Ding. Ding. Ding. Exactly. It's one of the biggest fricking complaints of these corporates where these kids go there and they're all happy but they have to use this lab. And, they hate that lab, and it's the deal breaker. And then the CEO, in his next breath, will talk about how do you stop staff turnover. And, it's like, "Well, you stay humble. You listen to them. Why is she mad? That lab, she doesn't like." And, whether the lab is right or wrong ... Hell, you can't get two dentists to agree that today's Thursday. So, you know. But anyway, continue. I'm sorry to interrupt.
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Seth Gibree:
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I was gonna say, that's one reason we haven't gotten into the lab business. So, why put that potential barrier between you and your clinicians? It makes no sense.
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So, and that's the same thing with supplies. So, ultimately doctors have the choice of what they're using. The job for us is to help coach them along to make the best decision for them and for their office. Because ... I mean, they're invested in the practice itself. We have over 350 doctors that are share holders in the company because they understand that when the company's successful, they're successful. It's a privately held company, but they're investing their own money into the office and into the company.
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And that's the same thing with why we want to give our doctors choices because ... And this is the biggest thing right here is, they're gonna tell me what to diagnose. You're gonna make me do crowns or you're gonna make me do root canals. Or everybody's gonna get scaling and root planting. No, because the decision is between the clinician and the patient.
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I mean it's the hard thing about insurance companies denying what a patient needs, or what a doctor says a patient needs, from somebody that's multiple states away that's trying to intervene into their relationship. It's a doctor-patient relationship and it's a local based, community based service.
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And so, it's so important in my mind, in our minds, that people understand that. That the decision for the doctor on what the patient needs is their decision. If they're in there working and they're doing fillings on two, three, and four and they see, oh, number five needs something and they say, "You know what? We're in here, let's do number five for free today. I want to give that to you." They have the autonomy to do that and nobody's gonna knock them down or police them or looking over their shoulder.
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And so it's the same thing with labs too is that ... You know what? We have a great network of labs. We have some great labs that we work with and that we get great pricing at. That is the nice thing about having almost 800 offices is that it does give you some buying power. And so, we have great labs, but it also gives us the ability to streamline processes and make sure that they're providing good quality to us. I mean, there's ... When you have that much buying power, it offers you kind of checks and balances to make sure you're getting good service both customer service wise and quality wise.
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Howard Farran:
|
So do they have to pick a lab from that list?
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Seth Gibree:
|
No, I mean, they're gonna get the best deal from that list, but they're ... But within ... But, you understand. So if we work with a group of dental labs like, GPS is a group of labs or NDX is a national dental group of labs and so, it's not just one lab. Underneath their umbrella, there might be hundreds of labs. And so, there's hundreds of different options for them to choose on, where they get best product at best pricing. So they have options. They might use ... I use a lab that's 20 minutes away from me that's under our umbrella of labs that we use. But there's hundreds of labs all over the US that we have partnerships with.
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Howard Farran:
|
So do you have ... So you have a list of those labs?
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Seth Gibree:
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I do.
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Howard Farran:
|
Can you email me that list? I'd love to see that list. I've a ...
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Seth Gibree:
|
I will check on that.
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Howard Farran:
|
No, no. I won't make it public or anything. I'd just love to see the list.
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Seth Gibree:
|
Yeah. Yeah.
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Howard Farran:
|
I'll tell you what. In all seriousness, I think laboratories have changed more than dentistry in the 30 years that I've been out.
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Seth Gibree:
|
Huge changes. Huge.
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Howard Farran:
|
I mean, they went from 1500 to 7500 and it's basically 100 labs have all gone digital. I mean, how can you say your labs better than my lab when robots and CAD/CAM's are making the damn crowns? I mean, you can't say ... In fact, you can't even say this lab is better than this lab if they're using the same technology. Milling ... You know what I mean? I mean the laboratory's gone so digital. I mean, did you ever think you would see the PFM go the way of the dinosaurs?
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Seth Gibree:
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No.
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Howard Farran:
|
And the PFM's were made by cavemen sitting on a work bench and waxing, and fire and all that stuff. Now it's all gone.
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Seth Gibree:
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That's a lost art. Oh yeah. It's even ... Look at removable. I mean you go visit a lab and the removal department, the guys that are in there have been doing it a long time and they're all in their sixties plus, and that's the majority of them. And so, that art ... It's an art and I mean, that's the kind of way labs were. One of the big things I would challenge a doc to do is go to a lab and see the junk that they get. And then they and we complain about the stuff that we get from the lab. And it's like, man, if you go and see what they deal with the majority of the time, you'd be shocked. And so, I mean, kind of junk in and junk out, so make sure you're giving them good work to be done.
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Howard Farran:
|
Gordon Christian told me yesterday on yesterday's podcast that only 20% of labs that dentists send, disinfect their impression before they send it in.
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Seth Gibree:
|
I believe it.
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Howard Farran:
|
That's why the labs are pro scanner, because they don't want to get your dribble tray with a little cotton role in there and there's still blood oozing on it and they're like, "Did these guys not take Biology?"
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Seth Gibree:
|
You take it out and saliva drops off of it. Oh yeah.
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Howard Farran:
|
I mean, it's just amazing and zirconia and cadmium. I think Jim Gladwell said it the most interestingly. I was listening to him lecture in Chicago and he was saying that the first 10 years of Gladwell, they would hire five people every Monday and it would take them a whole year of training to get them to make five PFM's a day. And then those would have 6% remake. Now he takes five people every Monday, only trains them for one week on CAD/CAM and then they make 50 a day with less than 1% remake.
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Seth Gibree:
|
I was talking to a lab today, actually this morning, that they've been dealing with the digital process for about eight years. So they're kind of further along in this process than some of the other ones and they have a good check and balance kind of in place. And they're remake rate is under half a percent on their CAD/CAM.
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Howard Farran:
|
See that's why I wanted that list of deals, because I kind of look at my list of podcasts and I've given like 25 hours of the greatest orthodontist. 25 podcasts of the greatest endodonts. I mean, basically if you're an endodontist whose wrote a text book, I've already podcast you. And the implants ... So I like to move it around.
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Seth Gibree:
|
Sure.
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Howard Farran:
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I've been thinking yesterday, I need to talk to more legends in the lab business, someone who's been there 30 years. I'd like to talk about it because it's so changed. I want to keep going on.
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Seth Gibree:
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Sure.
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Howard Farran:
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So, everyone's probably wondering what practice manager software? Do you guys use something off the shelf? I mean are you guys using Eaglesoft or Dentrix? What are you guys using for practice management in those 780 locations?
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Seth Gibree:
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The one that you love so much, Dentrix.
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Howard Farran:
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Which I thought was so weird because Rick's from Effingham, Illinois, and right up the street is Eaglesoft.
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Seth Gibree:
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Sure.
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Howard Farran:
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You just would have thought they would have gone with Eaglesoft because they're in the same town of ten thousand. So, Dentrix, but are you using an off the counter software from Dentrix that I could buy? Or do you guys buy the software and then get your own programmers to add in all the financial QuickBooks online, all the stuff you need to run that big of an operation.
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Seth Gibree:
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So it ... Yes and no. So yes, it is a Dentrix basically off the shelf that Cheyenne has helped to tweak.
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Howard Farran:
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Is that the Dentrix enterprise?
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Seth Gibree:
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It is. It's a little before Dentrix enterprise.
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Howard Farran:
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Okay. Which one is it?
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Seth Gibree:
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I don't even know, which specific one we're currently running because we just upgraded to a new one. And we're looking at a couple of other ones too, related to Dentrix and tweaks with it. So, Dentrix has been great over the years about customizing solutions for us on specific things that we look for.
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Howard Farran:
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Well, you know, we were talking about Dentrix. They ... Well, I'm just not gonna let it go, I still think the biggest curse in dentistry is, you know when ... I mean I've said it a million times and I'm gonna have to tell you a billion times because people just don't see the obvious and that is, when I go to 7-11 Circle K, they buy this bottle water for 80 cents and sell it for a buck, and they know that. And I go into the dental office, they do not know the cost of how much it costs them to be in that operatory for an hour. So you guys use Dentrix.
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I thought the biggest move in dental supplies this year was usually Patterson was the high end, high cost, high service and Henry Shine was the more low cost leader and gosh darn, Heartland ... Patterson got the Heartland dental supply account this year. Tell us about that.
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Seth Gibree:
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Well, I mean, again that goes out for looking at what's best for our doctors and our offices so they can deliver the best thing for the patient and so there's a process to bidding that out. And after all these years, of being next door neighbors in Effingham, it made sense that Patterson really stepped up and wanted to be a part of what we were growing.
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Howard Farran:
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But you say Patterson next door in Effingham. No, Eaglesoft was next door. But then Eaglesoft got sold to Patterson.
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Seth Gibree:
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Sure.
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Howard Farran:
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Was it the owner of Eaglesoft that helped get that account? Or who?
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Seth Gibree:
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No, it was just open. I mean they were an open process, open bidding process to what we were looking for out of our supplier.
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Howard Farran:
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And I think to these older dentists, you know, lesson learned from Heartland, is Heartland lets them choose their own lab. And you own your own office, you're 56 years old and you gotta listen to that young kid. Does he like the lab you use. Just because he's your buddy up the street doesn't mean your associates.
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Same thing with hygienist. I have met so many demoralized hygienists on Hygienetown because the doctor orders the supplies and she's like "He doesn't even do the cleanings. He doesn't know what he's talking about." I've never ordered the supplies for my hygienist. I just think that's arrogant.
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Seth Gibree:
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You mean you don't pick the prophy paste Howard?
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Howard Farran:
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No, and I believe it's just arrogant. And then these people who sell hygiene supplies, they do the studies because they want to know, should be advertising in Hygienetown to the hygienist or in Dentaltown? And their data always comes back and says advertise in Dentaltown because the dentists buy all the hygiene supplies. And I'm just like, "That is just so wrong." You know, you need to let the associate pick the lab. Let the hygienist buy her own damn supplies. We work with our hands, we're all surgeons. Hygienists, dentists, we're all surgeons. And if you work with your hands all day, I don't care if you're a welder or a plumber, you want the tools you like. You don't want to use the tools anyone else likes.
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And also the other thing you were saying about, in dentistry the most important thing is the soft stuff, and you gotta be nice. And you see it with the patients, because if you reach in their mouth and point to anything like a bridge, a gold crown ... I mean, you can point to a gold crown and say, "Who did that?" They never know. And I go, "Man, that was an awesome dentist. He got in your mouth, put on a gold crown and you can't pick him out of police line up. That is an awesome ... You should go back there." But the point is they never remember the dentistry you did. They only remember how you made them feel.
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Seth Gibree:
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Absolutely.
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Howard Farran:
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And you're a four time Ironman and I did it three times. And I see a lot of dentists ... The assistants tell you, there's threads on Dentaltown, where they're mad. They're frustrated. They throw instruments. And a lot of dentists work out after work and I think a lot of people ... If you're agitated and you're aggravated, and you're high strung, doing your work out before you go to work, getting all you're ya-ya's out, then you walk in there, then you're too tired to get upset with your patients and your staff and all that. And what is the opposite of that? They don't work out in the morning and then they're doing a couple of Starbucks coffees. So, now they didn't work out, they're amped up on caffeine and then they're snacking on chocolate caffeine and then they want to know why they threw an instrument during a wisdom tooth removal and yelled at their patient or staff or whatever. You gotta take control of the body. And I think the A.M. workout is critical when you are in the people business.
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Seth Gibree:
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Well, and I think that you said ... All you said to me that I hear, is you set the tone for your day. And how you choose to act and respond is how your team is gonna ... They're gonna follow your lead whether you like that or not. And so being able to, if it's journaling, if it's meditation, if it's getting your mind in the right way, the right frame. If it's getting endorphins out from exercise, which is what some of us get. There's so many ... Ninety percent of the time, I don't want to work out. It doesn't sound fun but I tell you what, when I'm done I'm happy. And I feel so much better and it sets the day differently for somebody.
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Howard Farran:
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When I don't want to work out in the morning, I just go to yoga anyway and I just take a lawn chair and sit in the back of the room with a beer and just watch the whole class do it.
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Seth Gibree:
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Yeah, it works really good. Very peaceful.
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Howard Farran:
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Yeah, it's a peaceful scene. The beer doesn't stay cool very long. But hey, we went over our hour. I just want to sit there and say seriously dude, you posted like 7,000 times on Dentaltown. I'm just a huge fan of yours, Seth. I just think you're the all American boy. So proud of everything you've done. The wife, the family, the business, the Ironmans, you're just the real deal. You're all that and two bags of chips.
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Seth Gibree:
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Thank you.
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Howard Farran:
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And I want to thank you so much for coming on the show today.
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Seth Gibree:
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Thank you and again, thank you for what you've done with Dentaltown because it did change my career and my path. And so I think, it takes a village to raise a child so to speak. And yes, but it takes good parents. And I think having ... I've been blessed. I mean, there's not doubt about it. I've been blessed with great mentors. I've been blessed with people that have invested in me and I've been in the right situations at the right time. And I feel that's where I am today. I feel I'm in a good situations to help others grow in a positive way. And so I kinda have that pay it forward mind set of what you've done for over the years and yes, your boys and my boys are kind of the cream of the crop of what we want to achieve in life, but if we can touch other people's lives for the better, then I think we are better for it. So I appreciate it.
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Howard Farran:
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Well buddy, pay it forward today. Hang up the phone. Call Rick Workman. Have him call Stan Bergman and Henry Sign and just say, "Dude, hook up Dentrix to Eaglesoft or Farran will never shut his fat face."
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Seth Gibree:
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You want Dentrix and Quicken together, huh?
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Howard Farran:
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I mean it's just ... I don't know how else ... I mean, I've got a dental degree and an MBA and I have to have two full time ladies exporting stuff in Excel. One side Excel, another ... I mean, it's just ... It scales the economy.
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Seth Gibree:
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Oh absolutely.
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Howard Farran:
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I have 50 employees, so I can do this. But our average homie has five employees. He's got one hygienist, two assistants, two front office. He doesn't have the scales of economy to bring in a bookkeeper full time. And, you're not gonna find one single dentist in America who when he walks out of the operatory said, "Dude, you just did two fillings. What did it cost you? What did you make?" And not one of them knows. And that's why 82% of dentists are taking PPO's. If they actually knew how much money they were losing, then the PPO's would either have to raise their prices or they're gonna lose providers because a dentist doesn't want to do an MOD composite and throw 20 bucks away. If he wants to throw 20 bucks away, he'd rather go to, the mall or go to Subway or [McKyle's 01:02:40], or you know. He doesn't want to do an MOD composite to lose 20 bucks. There's a lot better way to spend 20 bucks than to do an MOD composite.
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Seth Gibree:
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I agree. One thing that I wanted to mention in my experience is that it's gonna be harder as time goes along with students having this much debt load, being able to sell practices. And, for me, being able to still practice but take out some of the equity of my situation ... I mean, I affiliated with Heartland at 35, so I mean, I still have a long time ahead of me, but it made sense for me. So I think figuring out what makes sense for each individual is important. And that's where having opportunities like the DSO market where doctors can say, cash out some of their equity, put some money in their pocket, or their wives pocket, and then still work for however long they want to work, but not have the stress that they had before was a super important part of my journey too. And it's allowed me to find balance and read books like "Tools for Titans" and other stuff.
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Howard Farran:
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Uh, we gotta ... Well a lesson everyone can learn at any age of the game is whenever I meet dentists, whether they are in dental school, been out 5 years, 10 years, 20 years, they all live way above their means. They all think they're the lead guitar for the Rolling Stones or something and you're not Rod Stewart. You're a dentist. And why do you need that big mansion, and that big fancy car and why ... And again, that $350,000 of student loans. I mean that's only half of what a dental office costs. That's only a third of what a divorce costs. They're gonna spend chunks of change, two, three, four, five times that size before they go underground. The main thing is, just live below your means. I tell everybody all the time, it's 2017, my car was made in 2004. Why the hell do I need a new car?
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Seth Gibree:
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I had a 2003 until like a year ago and then I got a new car for me, which was four years old. So I drive a 2012 now.
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Howard Farran:
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Yeah and how many of these dental students could just go back and live with mom and dad for three years and work six days a week? And live at home and literally pay all their debt off in three years.
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Seth Gibree:
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But they don't want to do it.
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Howard Farran:
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But they don't do that. They want to go get, not just a home ... They don't want to get a three bedroom, two bath, 1800 square foot. They want a three, four, five thousand ... Their first house will be bigger square footage than their parents house and their grandparents house combined. It's like, where does that come from? What ...
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Seth Gibree:
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Because somebody will loan out the money for it.
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Howard Farran:
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Yeah, exactly. So again, man. Dude, thanks for all you've done for dentistry. Give your wife and kids a kiss from Uncle Howie.
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