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Howard Farran:
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It is just a huge, huge honor for me to podcast interview my buddy for long, long time Eduardo Ricco all the way from Sao Paulo, Brazil. He graduated at the University of Sao Paulo in 1990, just in the middle of a political economical crisis and impeachment process of Brazilian president Collor. Just the same as last year with ex-president Dilma, and between not more than little gaps of prosperity in Brazil. Gaps of opportunity, which he took. As his country opened his market, he took part in an experience with networking marketing where he met Zig Ziglar, Stephen Covey, Tony Robbins from whom he became a partner with bringing Tony Robbins' practice management group Fortune all the way to Brazil.
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He also brought his dental mentor and hero Dr. Howard Farran to Brazil for a seminar at the APCD Sao Paulo and Dentaltown, launching the website and magazine. God, was that year 2000?
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Eduardo Ricco:
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2000, yeah. Right there. Your Dentaltown, first year.
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Howard Farran:
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Oh my gosh. I don't think I've seen that in 20 years.
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Eduardo Ricco:
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Oh, it's my pleasure.
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Howard Farran:
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Awe, you're so kind. He went on to learn orthodontics, occlusion at a hospital. I can't even read all these names, I'm sorry they're in Portuguese.
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He is also a member of APCD that promotes yearly an international congress CIOSP, where he was president of one of its Regional, and nowadays he is member of Conselho Deliberativo House of Delegates. Last year Dr. Ricco was collaborating with his community as Health and Dental Director in public service, but his secret is his beautiful family, three children, Luiza, Ana Lia, Dado, and his wife Monica.
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Now I could not imagine doing a podcast in Portuguese. I only speak English and when I meet someone like you that can speak Portuguese and English, my hat's off to you, and since English as a second language is so difficult, I don't want to do much talking. I'd rather you just talk and tell us all about Brazil, what it's like to be a dentist in Brazil, I know you guys have 200 million people with 150 000 dentists. I've been to Brazil probably a dozen times. It's got to be the most beautiful country on earth. How is it like being a dentist in Brazil these days?
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Eduardo Ricco:
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Yeah, okay here we go. It's an honor, thank you for your invitation. We have a Brazilian writer Paulo Coelho and he says somethings like, "There are some magical moments in our lives", and I know this one is one magical moment. Sorry for my English not so fluent. It will give some fun for the audience and for you.
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Anyway, welcome to El Tomas, the downtown community, which I pleasure to be part of it as the Brazilian Coordinator here in Brazil where 283 000 dentists. It's a jungle to be a dentist, yeah. In 2017, 280 000, 83 000 dentists.
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Howard Farran:
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That's more than the United States.
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Eduardo Ricco:
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Yeah, and the population is even smaller. Actually smaller.
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Howard Farran:
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What is the population in Brazil?
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Eduardo Ricco:
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Around 2 000 millions.
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Howard Farran:
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So, 200 million, and the United States has less dentists and it has 325 million. So that is a very, very competitive market. It must be very hard to build a practice with that much competition.
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Eduardo Ricco:
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Yeah, from one side we have a very low healthy in mouth, and lots of people to need a dentist, but on the other side there's no money that our income is very low comparing with the USA.
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Howard Farran:
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How many years did all the dentists go to school? Do they all go to school the same length of time?
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Eduardo Ricco:
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Yeah it's easy to become a dentist here in Brazil. Four or five years and you done. There are lots of dental schools in the last 20 years. The increase of dental schools was huge. In my state, Sao Paulo, there are 30% of all dentists in just one state, is the richest state in Brazil. There are very concentrated here.
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Howard Farran:
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Are all the dentists making a living, or do some of the dentists have to take part-time jobs to supplement their dentist income?
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Eduardo Ricco:
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Yeah, it's looks like some dentists cannot be successful in their dental practice these days.
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Howard Farran:
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What percent?
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Eduardo Ricco:
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I don't know how to the numbers, but the young dentists have hard time here to begin. I am the third generation in my family. It looks like that boy that you interviewed in Cambodia, and I'm easy to begin cause my father left the practice for me.
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Howard Farran:
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Do many dentists that you know also have part-time jobs that are not in dentistry to supplement their income, or are most of your friends able to provide for their family just from dentistry?
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Eduardo Ricco:
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No most of my classroom mates are doing good. We are in a very good regime in Brazil in our state of Sao Paulo, and it's a good place to be dentist. We can do it well with our family.
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Howard Farran:
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What are you passionate about in dentistry these days? What makes you get up in the morning with a smile?
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Eduardo Ricco:
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Yeah, that's a good point. That's why I think I'm here, and that's why I want to share. I think I need a, like a music in my mind and I want to sing my song. And it's interesting cause as you read it in the beginning, it was a network marketing and internet. Internet was kind of revolutionary.
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Back in 98 I asked if there was on the internet something like practice management. It was a search. I went to the internet in 98 and I found some dental articles and dental success like some doctor Howard Farran. Dental success, the future's bright on the other side of managed care monsters. Good article doc. And then I begin studying practice management, which is with my English I bought some books from PennWell, and this little one was okay, Morton Ehudin.
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Howard Farran:
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Successful Practice in Good Times and Bad, who was the author?
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Eduardo Ricco:
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Morton Ehudin from Washington D.C. Morton is an old one. I paid 10 dollars from this book on PennWell website, and then when it arrived to here I studying and look for some information and I thought Rick Kushner, it seems like a good idea. Why I don't fly to Denver and to Rick Kushner, cause it looks like interesting. Then I went to ADA in San Francisco in 98. Then fly to Denver, Colorado where our friend and just a parenthesis, we need to bring Rick Kushner here for a podcast. I know you are inviting him, so I am asking him too to come for a podcast. We need Rick Kushner.
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Howard Farran:
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Oh I love it.
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Eduardo Ricco:
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Then, yeah, Rick Kushner gave me his new letter. His publication The Simple Truth, How Winners Think, isn't it good? Then I could understand the business sides of dentistry. Not only technical aspects of dentistry. Cathy Jameson said something like, "15% is technical expertise and 85% is communication, case presentation", and then I start to deep and deep in the studies.
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We don't have practice management in Brazil. It's look like we have some kind of marketing and it's not the dentists that looks for marketing is bad dentist. Only the good ones are the technical and go for the dental schools. I'm sorry. So, practice management opened the doors for my success in my practice.
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Howard Farran:
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I found that book on Amazon. Let me ... Yeah, it was by The Successful Practice in Good Times and Bad by Morton M. Ehudin. Can you email me his name? That is just fantastic.
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Eduardo Ricco:
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Yeah, I almost brought him to Brazil. I'd like to have some news from Dr. Morton. I already said thank you for him, by the way good article in Dentaltown this month. We need to do internal marketing and this I learned from all of you. Every new patient gave a coffee mug for a new patient that come. And it is terrific. Internal marketing is the best way to give, bring in new patients.
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Howard Farran:
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Absolutely. Do you read Dentaltown magazine on the internet?
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Eduardo Ricco:
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Every month.
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Howard Farran:
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Where do you read it? Do you read it on Dentaltown.com, or do you read the digital edition?
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Eduardo Ricco:
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Everywhere. On the cellphone, on the internet, digital edition.
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Howard Farran:
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The digital edition?
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Eduardo Ricco:
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Yeah.
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Howard Farran:
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That's what I love about Dentaltown magazine, because we print it and mail it to 125 000 dentists each month, but it's emailed all over the world digitally. Just the internet is so amazing.
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Eduardo Ricco:
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Yeah, I think my paper in this too translated to Portuguese, and bring this information to Brazilian dentists. It will open the mind everywhere.
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Howard Farran:
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You said you translate to Portuguese?
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Eduardo Ricco:
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Yeah.
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Howard Farran:
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You mean in your own head, or do you translate it on google?
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Eduardo Ricco:
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Sometimes the, your article, the digital's corner is terrified and I translate on google and send to my friends, dental friends.
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Howard Farran:
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Wow. We ought to have you, we ought to get you on the team to translate the entire magazine and then email it to those 283 000 dentists. How big ... How hard would it be to find their emails?
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Eduardo Ricco:
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No it's easy. It's easy. That's why I'm trying to say to you, we need to bring it to Portuguese language in, isn't it?
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Howard Farran:
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Well let's do it. Now the big, what is the biggest Brazilian dental company? Is it Neodent?
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Eduardo Ricco:
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Yeah I think Plantdent. I mean plant, for implants. Really ahead now, and Henry Schein coming to Brazil and we have Dental Cremer and this. But we have a lot of manufacturers. Dental chairs, here in my city, here in Al Preto. We have very big ones, like A-dec, [inaudible 00:13:55]. It's a good version from medicine manufacturers.
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Howard Farran:
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What percent of dentists in Brazil can read or speak English would you say?
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Eduardo Ricco:
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Yeah, I'm trying to look for this information but it's very ... You know I'm not fluent in English. I study it several years but we get some more fluent one. But I'm following you and can understand.
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Howard Farran:
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Well you know-
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Eduardo Ricco:
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But perhaps 5%-
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Howard Farran:
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Yeah, they call it-
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Eduardo Ricco:
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Would in English.
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Howard Farran:
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They call it the rule of 50 million. If you're born on earth and you have 50 million people to talk to in your language, you don't need to learn a second language. Like when you go to Europe, when you get to countries that are under 5 million, or under 10 million like Denmark, Sweden, Norway. Those people speak five languages cause they've got to talk to the Germans, the French, the Italians, the Spaniards.
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When you're born in a country as large as Brazil with 200 million people, there would just be no reason to learn a second language. That's what you find all over the world, is that if you're born in a country of more than 50 million people, the people really don't need a second language. I think your English is amazing, especially considering I've been to Brazil a dozen times and I can't say one thing in-
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Eduardo Ricco:
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Portuguese.
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Howard Farran:
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In English we put a Dr in front of the name. In Portuguese you put a DrA?
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Eduardo Ricco:
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No, Dr. DrA is for women.
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Howard Farran:
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Oh. Is that what that is? So Dr is a man, and DrA is a woman? I always have to think about that, so Mario is a boy, and Maria is a girl, so DrA ends in a, Maria. I never ... I always wondered why so many Portuguese dentists email me and their last name, it was DrA. I had no idea that meant they were a woman. Interesting. How do you say dentist in Portuguese?
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Eduardo Ricco:
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Dentista.
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Howard Farran:
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Dentista, same as Spanish?
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Eduardo Ricco:
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Yeah, yeah. Dentista.
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Howard Farran:
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Yeah I love your languages more because there's the five languages that came from Rome, the romance languages. Romania, Italy, Portuguese, Spain and French. And you can see how common the writing is between those five romance languages, whereas English was an open language, so there's hardly any rolls. It's just, "i before e but after c." It's the craziest language learned. They say the only harder language to learn than English is Vietnamese.
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Eduardo Ricco:
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What, Vietnamese?
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Howard Farran:
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Yeah, and you know why? Because they will say the exact same word, but how they ... What is called when you-
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Eduardo Ricco:
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The accent?
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Howard Farran:
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What?
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Eduardo Ricco:
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The accent.
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Howard Farran:
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The accent? The accent, how you accent the word is six different meanings per word. You have to learn the language, and then you have to learn the tone and the pitch. They just it's just complete impossible to learn if you start learning it after the age of 12 or 13 or 14 you're just never going to get it. I commend your English.
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But yeah, I would love to bring you on the team and start a Portuguese edition. I think that would be amazing. I mean the stakes are so high with 283 000 dentists speaking Portuguese in Brazil, to get them high quality information, I mean you could help. You and I combined, we could help so many Portuguese dentists. I think that would be a beautiful thing.
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Eduardo Ricco:
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Yeah, this is my burning desire, my dream, and what is life about? It's working and helping others to grow. We can work on it.
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Howard Farran:
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How is it, Tony Robbins' group doing down there in Brazil? His Fortune management, how is that going?
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Eduardo Ricco:
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Yeah, continuing my saga. In 2000 you went to Brazil and we talk a lot, and you help with the our 30-day. 30-Day MBA. And I went back to USA at the ADA, A-D-A session, this time in Chicago. Then there was a Fortune management Diane Crenshaw from North Carolina, and she went to Brazil and we began to translate the material and work with some colleagues, with some dentists, and working for hands, and all the scheduling time, monitoring, timing my procedures. But then another political crisis, and by the way you read it about when I graduate in 90, and the Netflix is getting some follow here in Brazil cause the newspapers are more popular with political scandals nowadays, today. Then House of Cards.
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But anyway, in 2000 we have a little problem. The left government from Lula, president Lula. He won the elections and the dollar go to the orbit. It went 50% and then fortune management became hard to sell here in Brazil, and pres just gave up. So, just Eduardo with all the Tony Robbins and I went to San Diego for a fortune event in 2001. And anyway, this is, fortune is no more in Brazil. Fortune is only on the internet for Brazilians.
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Howard Farran:
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How is the, right now the big scandal in Brazil is the Car Wash Scandal?
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Eduardo Ricco:
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Yeah, last year we pitch president Dilma, but 15 days ago some recordings over the phone that our actual president Michel Temer with some bad news. I think it will not end till next year, his government. He will be impeached too. So dollar raises, and it’s a terrible mess nowadays, he is. We are at the worst recession from this last 25 years since I’m working dental practice this two years were the worst. Bad times here. Political crisis and recession make a longer recession.
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Howard Farran:
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But you look great, you look happy, you look upbeat. It doesn’t seem to be bothering you. Is it because your three children and Monica make you not care about the economy?
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Eduardo Ricco:
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I don’t know I think it’s the shirts, your t-shirt, you’re as beautiful as mine, we’re look like a chest. Anyway 25 years in dentistry and we are more like Rick Kushner called we are book, some kind of books. We are more stabilized and it’s easy, but the newest dentist they are having big problem for their patients, and-
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Howard Farran:
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I try to put it in perspective because in the 2008 financial meltdown, 86 dentists went under where I live in Phoenix, and a lot of people were singing the blues, and I say, “Okay now let’s look back at America. There was a civil war, which killed one million people when there were only 30 million people in the country, so one in every 30 died during the civil war, and they fought with fire back then, and everything was made of wood so they burned down half the country. Then you had World War I. Then you had The Great Depression. The stock market crashed in 29, and from 32 to 36 we had 25% unemployment. Then we come out of that and go right into World War II, where six million boys were shipped overseas, and a third of a million don’t come back times 10 wounded.”
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So in perspective, in today’s rich world, they seem really bad, but when you go back in time our grandparents lived through a lot of tough stuff. Your third-generation dentists, I’m sure your grandfather lived through incredibly difficult times too.
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Eduardo Ricco:
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Yeah sure, I’m sure of it. I remember you telling me back in 2000, “Eduardo, we’re in a country a rich country as Brazil doesn’t work, there is just one word: corruption.” You said it to me 17 years ago, I can’t forget it about it, and it’s corruption we have here in Brazil. That time was Car Wash will be doing a good job and the futures will be better.
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Howard Farran:
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Yes, when the Nobel Prize winning economists do research on countries asking them, “Why does this country have all this resources, and farming and minerals, and then other countries like Japan who has no agriculture, no mining, no resources, do so well?” And they study it. It always comes back to the number one factor in poverty is a corrupt government.
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Eduardo Ricco:
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Yeah, it’s clear now, and it’s getting more clear every day. But anyway, the Preto police is doing a good job. In the past there wasn’t this kind of investigation, so the future will be better. I’m sure of it. Even being dentists we have implants, we have resins, we have porcelains, beautiful smiles, and my father only do amalgams and extraction and dentures. Nowadays I need to compare it, the dentures into fixed implanted supported dentures. It’s better, isn’t it?
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Howard Farran:
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You know, Venezuela is a classic example. They had the most natural resources of all of Central and South America. They had more oil money than any country down there, and look at their economy now from … I mean they’re completely in depression.
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Eduardo Ricco:
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Yeah, but you gave us some game to play.
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Howard Farran:
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What are you mostly excited about? Clinical dentistry, are you doing orthodontics? Are you doing ... What are you doing? Are you placing implants, cosmetics? What are you most passionate about today?
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Eduardo Ricco:
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Yeah today have an article in this. It’s about All-on-4, yeah?
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Howard Farran:
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Yeah.
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Eduardo Ricco:
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All-on-4 and dentures over implants.
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Howard Farran:
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You know, the man who invented that is Portuguese from Lisbon, Dr. Paulo Malo.
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Eduardo Ricco:
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Paulo? Yeah.
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Howard Farran:
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Paulo, is it pronounced Paulo Malo?
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Eduardo Ricco:
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Yeah, he’s from Portugal. I went to his clinic in Lisbon last October. The whole building. He went to Brazil some years ago and he’s terrific. All-on-4, Paulo Malo.
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Howard Farran:
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Can I tell you about my first trip to Lisbon, Portugal?
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Eduardo Ricco:
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Yeah, sure.
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Howard Farran:
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Well I was 17 and I went to a Catholic high school, Bishop Carol. My two oldest sisters, when they left high school they went straight into the catholic nunnery. They had big recruiting programs. To recruit boys, they rented a 747 packed it up with 450 catholic boys from the high schools in the area, and flew us all to Lisbon Portugal where we stayed in a priesthood seminary in Fatima, and usually that trip they send 454 boys and usually they get at least between 10 and 20 to cancel their return flight home and join the seminary. It was a massive recruiting deal. For two weeks they were trying to convince me to be a priest, but it was my first trip out of the United States. It was my first-
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Eduardo Ricco:
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17?
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Howard Farran:
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Yeah, I was 17. I had the time of my life. I can still remember catching a plane at New York City and seat in that, and flying over the ocean, and landing in Lisbon, and it was tough times in Lisbon. I think it was 1970. I graduated high school in 80. I think it was 76 or 77 and they had just gone through an attempted communist takeover, and it was like-
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Eduardo Ricco:
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Yes, Salazar. Salazar was the dictator. Ditador, it was bad times in Portugal.
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Howard Farran:
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Oh, there were red hammers and sickles painted graffiti everywhere, and they kind of disseminated the economy, but it was still, it was just so beautiful. The thing I love about Europe is, in the United States it’s hard to find anything that’s 100 years old, but you go to Portugal, you go to Europe and I mean it’s nothing to find something 500 or 1000 years old. It was just so beautiful.
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Eduardo Ricco:
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In Brazil too is all old things are new, but 500 years only.
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Howard Farran:
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Talk about Neodent. Neodent is one of the largest dental implant companies in the world. It was just bought by Straumann out of Europe, and now we see the Neodents coming into the United States. Are you placing implants?
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Eduardo Ricco:
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Yeah, I’m placing Neodent. I saw them on the Greater New York Dental Meeting last December. Neodent are the first and the biggest Brazilian implants we have. Another ones we have thousand and thousand of people to do implants here, you know? And this company’s start 20 years ago and just blow up. Neodent, and-
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Howard Farran:
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Are they made in your city, Sao Paulo?
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Eduardo Ricco:
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Yeah, and is in Parana, another state down in Sao Paulo. We have in Sao Paulo on a Connexion. Connexion is a good one too.
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Howard Farran:
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Do you know the owner of Neodent?
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Eduardo Ricco:
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Yeah, he’s a colleague. Just a dentist.
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Howard Farran:
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I want to podcast him.
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Eduardo Ricco:
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Yeah, I can link you with him. It is a good idea, Geninho.
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Howard Farran:
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I think Neodent is going to do very well in the United States, because the price of Neodent is so much less than the expensive Nobel Biocare or Straumann. He’s definitely going to have the low-cost Ikea, Walmart, Southwest Airlines, he’s going to be the low-cost implant provider. The fastest way to increase sales in any business is to lower your cost and lower your prices, and he’s definitely going to be the low-price implant, the major low price implant.
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Eduardo Ricco:
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I’m remember last week I saw the movie The Founder, for McDonalds, and I don’t know about Phoenix, the second McDonalds. It’s an amazing movie. The story of McDonald’s and supply and demand, and I remember you MBA. Anyway, back to implants. In Brazil is cheaper than United States to have this treatment, so I write all the Americans that. I fired off money, come to Brazil to treat, we have tourists, and then healthcare, we’re working on this kind of tourism too.
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Howard Farran:
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How much would it cost to get All-on-4 and on a fixed bridge? Well there was All-on-4. I guess Brand Mark started All-on-6, and then it went to All-on-4. How much would that … In the United States, one arch of All-on-4 at ClearChoice is about 25 000 dollars US.
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Eduardo Ricco:
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25? Here is around 3 000.
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Howard Farran:
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Would it be an equivalent All-on-4 with a fixed bridge, or are you talking All-on-4 with removable?
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Eduardo Ricco:
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No, fixed bridge over metal and acrylic.
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Howard Farran:
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What do you think is better for the implants? All-on-4 removable, or All-on-4 fixed? Because when they’re removable you can sure clean everything so much easier. When they’re fixed it’s kind of a … I think it’s far more difficult to clean.
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Eduardo Ricco:
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Oh, excuse me. We have Branemark. Branemark, the Sweden doctor, left us in 2015. He went to Brazil and he opened a dental school in Bauru. Bauru where I went to do my implant training. And Dr. Branemark, the golden pattern is fixed, the Branemark protocol we call here. Isn’t it? Branemark protocol? Hixton.
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Howard Farran:
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He lived in Brazil the majority of his remaining years. Did he actually die in Brazil, or was he back in-
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Eduardo Ricco:
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No, he was back to Sweden.
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Howard Farran:
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When he actually died?
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Eduardo Ricco:
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Yeah.
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Howard Farran:
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I tried to podcast him before he passed away, and he wasn’t well enough at the time.
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Eduardo Ricco:
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He was a blessed person.
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Howard Farran:
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Oh my gosh. He changed dentistry.
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Eduardo Ricco:
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He helped a lot of people in Brazil with his implants and left a dental school, them to look for people that can’t afford the private treatment, and All-on-4 and all of this kind of implants. Just a minute, we have … This are the Branemark Dental School in Bauru, in Brazil, and we have some kinds of implants for nose, or eyes, or finger. All of this in Branemark in Sao Paulo here in Brazil, doing well.
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Howard Farran:
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Does his son ever come down to Brazil? I know his son’s in … Dr. Branemark, his son was an orthopedic surgeon in San Francisco.
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Eduardo Ricco:
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Yeah, I don’t know about his son.
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Howard Farran:
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Yeah, I need to podcast him. That would be an interesting podcast, he’s a great guy. Out of those 283 000 dentists in Brazil, how many of them have ever placed an implant, what percent?
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Eduardo Ricco:
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Oh, 10%.
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Howard Farran:
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Only 10% place implants?
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Eduardo Ricco:
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Only 10%.
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Howard Farran:
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Why do 90% not place implants?
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Eduardo Ricco:
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I don’t know. As we have a lot of dentistry here, some dentists go only to do endo, others pediatrics, other perio, and we have specialties. I think it’s the main reason.
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Howard Farran:
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I thought a lot of general dentists in Brazil placed implants, but you’re saying not so much?
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Eduardo Ricco:
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Yeah, I don’t know the right number to tell you. I think it’s 10%. In my hometown, we have 10% that place implants.
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Howard Farran:
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If an All-on-4 costs 25 000 an arch in the United States and it costs 3000 in Brazil, and Brazil is a vacation paradise, are you having much success getting Americans and Canadians to fly down to Sao Paulo?
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Eduardo Ricco:
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We have some from Portugal. Portugal is something like this. Is cheaper here and there is no barrier of the language. In Portugal they speaks Portuguese and they come to Brazil. I have some patients from Portugal.
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Howard Farran:
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Now, is their dialect very close to your dialect, or is it pretty different? Their Portuguese versus Brazilian Portuguese.
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Eduardo Ricco:
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No, it’s quite similar. Just some words that is funny that change it.
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Howard Farran:
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What else are you doing besides … Is implants a big part of your practice? Is that the major thing you’re doing?
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Eduardo Ricco:
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Yeah clinical is the passion, and we start off doing surgeries. It’s the passion nowadays for us.
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Howard Farran:
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What about orthodontics?
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Eduardo Ricco:
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Oh, ortho, 10 years ago many schools began training and nowadays is a mess, ortho here. I just work on ortho preparing for prosthodontics or implants to use as anchorage, and it’s not my main clinical target, ortho nowadays.
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Howard Farran:
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Do you do endodontics too, root canals?
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Eduardo Ricco:
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Yeah, with your how can I say? You know, you say it. We need to do everything. So I do some perio. Last year I left pediatrics. No more children.
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Howard Farran:
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Come on, you have three children! Don’t you think it’s funny how you have three children that you love so much, but you don’t like to treat children?
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Eduardo Ricco:
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They are all teenagers nowadays. And by the way, congratulations for Ryan. I remember you were, “It’s a boy! It’s a boy!” But now they are men.
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Howard Farran:
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Oh my God, I can’t believe it. My baby is 22 and six feet tall.
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Eduardo Ricco:
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You are a grandfather.
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Howard Farran:
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Yeah, twice.
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Eduardo Ricco:
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What?
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Howard Farran:
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And Ryan is going to be 24 next week, and he’s six foot tall. God, I can’t believe how fast the time went. You also you mentioned you’re a big fan of Zig Ziglar and Stephen Covey. Stephen Covey just passed away a couple years ago. He was in Utah, fell off his mountain bike and bumped his head and died.
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Eduardo Ricco:
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That’s sad.
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Howard Farran:
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Any takeaways from Zig Ziglar and Stephen Covey?
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Eduardo Ricco:
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Yeah, Stephen Covey’s 7 Habits is terrific. We have some, you are here. You, Rick Kushner and the 7 Habits. Be proactive, sharpen the saw. Some painter from my city town. Anyway, Stephen Covey just change it, our lives.
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Howard Farran:
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Was that a picture of me on the wall?
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Eduardo Ricco:
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Yeah.
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Howard Farran:
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Oh, you’ve got to take a picture of it with your iPhone and text it to me.
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Eduardo Ricco:
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Okay.
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Howard Farran:
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Oh my God, that was-
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Eduardo Ricco:
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17 years ago. You know I went to New York last December for Greater New York and went to Dentaltown booth and got my pen, and when I was on the bus to the hotel, I look at the badge from Howard, Phoenix. I said, “No you’re kidding, you’re not the Farran.” “Oh, but I am Howard Goldstein, and I work with Howard.” They weren’t so short that we went to a very good talk on the bus the way to the hotel. Howard Goldstein?
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Howard Farran:
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Yeah, Howard Goldstein. He lives kind of by New York. He lives in Bethlehem, Pennsylvania. He does all of our message boards, moderation, and our online CE. It took me years to convince him to sell his practice, but he had 30 000 posts on Dentaltown. He had more than I did. And I said, “Howard you live on Dentaltown all day every day, please sell your practice and come work for me.” And he finally did, and now he has 411 online CE courses up, and he just works so hard. Then he also runs the moderators to where, when someone’s posting on Facebook that you don’t like, you can just unfriend them or block them, but in a Dentaltown forum where there’s a quarter of a million dentists and you post an implant case, and someone critiques it. Well a lot of dentists don’t like anybody critiquing or anything, but you have to say it in a very nice way and if you feel like it’s mean you just click the report abuse and then it goes to Howard Goldstein, Jason Luchtefeld, and other dentists, and they decide whether you’re being nice. It’s hard to get everyone to play nice in the sandbox.
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Eduardo Ricco:
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Dentaltown helped me a lot to bought the electric care. How do I say this? Fill it, electrical one. There was a group and I could get some information and select a brand. Bien-Air from Switzerland. I bought an electrical, and it’s my little Ferrari. How can you say Ferrari, the car?
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Howard Farran:
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You use electric hand pieces instead of air-driven?
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Eduardo Ricco:
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Yeah, just bought from New York and Dentaltown helped me to make this choice.
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Howard Farran:
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You know, that’s a very cultural. You go to some countries like America and everybody uses air-driven. And then you go to other countries and everyone uses electrical. Everyone that I know who has used both electrical and both air, they can’t believe everyone doesn’t use electrical. Do you like the electric hand pieces?
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Eduardo Ricco:
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Yeah, I’m loving it. For wisdom teeth and to cut it go straight ahead, just like a Ferrari. And the sound is like a Ferrari, amazing.
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Howard Farran:
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What you’re saying is the air speed doesn’t have very much torque. When you’re preparing a tooth you can stop the burr-
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Eduardo Ricco:
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It’s like driving a Ferrari.
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Howard Farran:
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Yeah, with an electrical hand piece you cannot stop the burr. The torque is so high, if you go forward it’s cutting through it.
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Eduardo Ricco:
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And the sound for the patient is like music.
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Howard Farran:
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Yeah the air-driven, that high pitch noise makes people cringe, and the torque is so low, but I think it comes down to this, you either grew up painting with oil or water paint, and it’s hard to get someone painting 10 years with water paint to switch to oil, and you can’t get someone from oil to go to water paint. Dentistry is hands-on surgery, and it’s an art and science, and if you’ve been doing your art for 10, 20 years ... And that’s why in dental school they made us wear gloves in the lab. They said, “We don’t ever want you to even feel what it’s like to touch a high speed, or to do anything without these dang gloves on. We want you to only know …” You know? I think in dental school they might really consider starting them out on electric because I think when you travel around the world, like I say, electric seems to be better.
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Eduardo Ricco:
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Yeah, I think I begin with implants. It’s electrical, and then endo, is electrical. It’s natural way for me to go to air.
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Howard Farran:
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That is a good ... That is profound, because all the oral surgeons use electric, because there wouldn’t be enough torque with the air and they wouldn’t want to create an air embolism, and every dentist doing endo is using ... Well, I don’t know, not everyone but most of them are using electrical hand pieces. Then you don’t have to have all that plumbing infrastructure. You don’t have to have air water pressure lines coming into all your operatories, so it uses less infrastructure.
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Eduardo Ricco:
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Yeah it was easy to adapt to here.
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Howard Farran:
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What else are you excited ... What else do you do? You don’t do pedo, you do endo, implants. You’re not into orthodontics, do you do much, a lot of fillings, any cosmetics?
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Eduardo Ricco:
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Yeah I think what I want to share with all the phone is that we can improve our way to work beforehands with scheduling, with procedure times, and I just got faster and efficient, and then my prices can be lower and help more people to fix his teeth, and that’s why I want to share this practice management principles with Brazilian people, cause we work in very primitive way. Not primitive, but slowly. It’s like on The Founder movie. We do one hamburger at a time, so we can improve two chairs, and see two patients. It’s fun for you two chairs, but you work on eight chairs. I went to North Carolina and did some practice that is terrific working. It’s quite a paradigm shift for us to work more than two chairs, isn’t it?
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Howard Farran:
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There’s two million dentists around the world and at least one million of them work out of one chair, and I remember the first time I lectured in Australia, it was 1990. I’m going to be lecturing again next month in Sydney and Melbourne. But when I first went there in 1990, the Australian Dental Association had me come and I was a keynote speaker, and I was talking about using more than one chair. This guy stood up and he pretended he was filing a root canal at both ends, that he was working on two people at the same time, and the whole room bust up laughing, and they could not even fathom the operational logistics that you would have two chairs. While you’re cleaning up one you could be working on another, then you could take a break, they just didn’t get it.
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Now they get it. Now that was 90, 2000. That was 20 ... My God, that was 27 years ago. 1990 to 2017, is that right? How long ago was that? 2017, yeah 17 years ago. Yeah, 17 years ago, and at that time they were just starting hygiene school. In the room when I lectured in 1990 everybody pretty much worked out of one room, and no one had a hygienist, and they were all booked up a month in advance. They didn’t understand why anybody would want to do marketing, because they were booked up a month in advance. So I said, “Well why are you doing your cleanings? Why don’t you have two or three chairs? You know, if you went to four chairs you wouldn’t have them waiting a month. You could get through all of those people this week.”
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Eduardo Ricco:
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We lost hygiene patients here too. The patients only come with pain, with broken teeth. The shortage of money, I think 10% do prevention. Cleanings, dental cleanings, and have visited for prevention. It’s not very good news.
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Howard Farran:
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Are there many hygienists in Brazil?
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Eduardo Ricco:
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No hygienists, only dentists.
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Howard Farran:
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There’s no hygienists?
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Eduardo Ricco:
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No hygienists, no. We do the profit.
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Howard Farran:
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But with that many dentists, I’m sure you could hire for low money a young dentist out of school to do your hygiene.
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Eduardo Ricco:
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Yeah, that’s the way we do. To begin practicing and dental assistant for us.
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Howard Farran:
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Now is a dental assistant allowed to do a cleaning?
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Eduardo Ricco:
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Yeah, there is allowed.
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Howard Farran:
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It’s allowed?
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Eduardo Ricco:
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Yeah.
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Howard Farran:
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Is there much legal oversight on dentistry? Is there a licensing credential like a board that if you do something wrong they’ll take your license away and you can’t practice dentistry?
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Eduardo Ricco:
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Yeah, we have a counsel.
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Howard Farran:
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Are they very aggressive?
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Eduardo Ricco:
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Nowadays we have a lot of attorneys as dentists. We have a lot of attorneys, and then they come to healthcare and there is creating this problem with professionals.
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Howard Farran:
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Do you think that’s a good thing or a bad thing?
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Eduardo Ricco:
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It’s a good thing. We’re looking for a test after lefting the dental school, but nowadays we don’t have a exam. All the students go and open his practice and go practicing.
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Howard Farran:
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Interesting. Right now it’s May, so 6000 dental students in the United States are getting ready to graduate next week. What advice would you give a young graduate who’s walking out of school at 25 years old and entering into the profession? What advice would you give them?
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Eduardo Ricco:
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Yeah, good question. Remember that dental school is only the first step. It’s the beginning, and go to Dentaltown, go to look for on the internet, look for practice management, and communication, read, read, and read lots of books on dental side, Cathy Jameson is terrific too, Great Communication. Anyway, continuing proving your technical skills but remember about the 85% about communication, Cathy’s presentation, and the future will be bright. I think I love this book from John Wilde, it’s like being a basketball player. We dentists, we’re not made all the same. Some are Michael Jordan, some are Magic Johnson, like Howard Farran, but there are ... This is a good one.
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Howard Farran:
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A prescription for success, wealth, and joy, by does it say, John A. Wilde, DDS? Nice.
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Eduardo Ricco:
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This book changed my life. We need to read, read, read every day. Keep studying, Continuing And Never-ending Improvement, CANI from Tony Robbins. We have a Netflix movie from Tony, I’m Not Your Guru. I’m not asking you Howard, to be my guru, my mentor, and this movie is interesting. You saw it? From Tony Robbins on Netflix?
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Howard Farran:
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I did not see that. I did not see Tony Robbins on Netflix.
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Eduardo Ricco:
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Yeah, it’s amazing.
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Howard Farran:
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Is it a new movie?
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Eduardo Ricco:
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Yeah, brand new, last year. I’m Not Your Guru.
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Howard Farran:
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I’m Not Your Guru.
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Eduardo Ricco:
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Yeah.
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Howard Farran:
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Interesting. I like that CANI, C-A-N-I, Constant And Never-ending Improvement. That’s why we say we practice dentistry, and you said something very profound that I hope doesn’t fly over everyone’s head, that is, “85% of success in dentistry is the people skills, the soft skills. Talking to your patients, making them feel good, not talking down to them. Not hurting them. Not disrespecting them, Staff, patients.” The people who are successful in any business are successful on the people side.
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Eduardo Ricco:
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Yeah it’s amazing. 7 Habits-
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Howard Farran:
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You could be the worst plumber in Phoenix, Arizona but if every old lady loved you, you’d be the busiest plumber.
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Eduardo Ricco:
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Yeah, Phoenix is amazing city, isn’t it?
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Howard Farran:
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Oh yeah, there’s so many retired people there. I swear, I think half the men that come in for their cleaning over 75 years old at my practice, only do it because Jen gives them a hug. I kid you not, sometimes when we’re busy they will stand there 15 minutes at the counter waiting to say hello to her, or say goodbye to her. It’s the relationship.
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Eduardo Ricco:
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Yeah, it’s about living. Living a life, isn’t it?
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Howard Farran:
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She knows all their names, and she knows everything about them. If their wife passed away, she remembers their name, and when it was. She’s just an amazing, an amazing human being, and that’s what humans are looking for. They never remember what dentist did this filling or this crown, they never remember that. They only remember if they liked that office, if they liked the people, and they remember why they stopped going back there.
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Eduardo Ricco:
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Yeah, dental assistants a key for success. My dental assistants work with me with 17 years. Patricia, she has a beautiful smile and every patient loves her. It’s interesting. Our team is very short here, we have just one dental assistant and someone helping on the telephone and scheduling. We’re working smaller practices.
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Howard Farran:
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Well it’s less overhead.
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Eduardo Ricco:
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Yeah, Rick Kushner’s kind of balding, I mean.
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Howard Farran:
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Hey, I did a podcast with one of my favorite dentists in the world, Gigi. It’s a Vietnamese name, it’s Gigi Han. In Vietnam, it’s like half the people have only six different last names. She has no employees, it’s amazing. She just has this square office, one chair, no employees, and she probably makes more than 90% of the dentists in California, and she laughs on that podcast because when you really look at so many of these dentists, what they mostly do is just provide jobs in the community. They’ve got two girls up front, an office manager, two assistants, two hygienists are running around like a chicken all day, and everything they do there’s hardly any net income. They might only have a 25, 30% profit margin, and she goes and does half the amount of production and it’s almost all net. She’s just nothing but net.
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Eduardo Ricco:
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That’s why lean and mean works well in Brazil. The lean and mean overhead.
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Howard Farran:
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Gigi is lean, but she’s not mean. She is lean and she’s sweeter than the tooth fairy. So Rick Kushner’s lean and mean, and Gigi is lean and beautiful, kind, and is the tooth fairy of Dentaltown. It’s an amazing podcast because as people switch from higher cash payments to lower PPO insurance their margins are getting squeezed, they really have to reevaluate all these high-overhead concepts that were developed when dental insurances were paying 40% more per procedure. When the insurance lowers your fee 40% and all your staff want a raise every time the earth goes around the sun, at some point you start realizing all I’m doing is creating jobs and stress, and then as you mentioned the lawyers, if you see five times as many patients in this big production facility, you have five times as much exposure to lawyers, and liabilities, legality.
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I’ll tell you what, half the dentists out there need to ask themselves this question: Do I come to work every day to provide jobs? Or to make money to provide for my family? I also know a lot of older dentists who will come in and do all their high intensity procedures in the morning, root canals, crown, and bridge. They’ll do everything from like seven to noon. Then they’ll go to lunch. Then they come back in the afternoon and all they do is recall, all they do is cleanings, and they say they love the afternoon, because they just come back, they do cleanings with their assistant, they work two chairs, two chair hygiene, and they just get to talk and bond with their patients that have been coming there a long time.
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The dental assistant will clean the room setup the room seat the patient, takes the xrays, then the dentist will come in. She’ll record while he probes, and then we he starts switching to scaling and doing the polishing, she’ll go to the next room clean that one up, set up for the next one, seat the next patient. They’ll do two cleanings an hour, and they say, “Hey I don’t have a hygienist, I don’t have any stress.” They’re too tired after lunch to come back and place implants, and do root canals, and do high stuff. You look at these offices where there’s just one assistant and one receptionist, and this doctor might only be doing 400 000 a year, but he’s taking home 250, and most of the offices that do 675 000 a year are only taking home 145. You’ve got to start thinking what’s going on when someone’s doing half the volume and taking home an extra 100 000 dollars than you. Are you just living on roller-skates to provide jobs?
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Eduardo Ricco:
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We need to work on our practice and make it a happiness.
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Howard Farran:
|
Now who wrote … Is that a dental book? Building the Happiness-Centered Business.
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Eduardo Ricco:
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Yeah it’s from Paddi Lund in Australia. You said about Australia.
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Howard Farran:
|
Oh, Paddi Lund.
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Eduardo Ricco:
|
We need to be happy here in our corner. I’m happy here in Brazil in my little corner of the world, and that’s where I live and where I grew up, and my children will grow up. We have some kind of problem, politicals, but in Europe we’re seeing the terrorism in America. Anyway, we have to be happy where we live, and look for our gift inside and be better each day. Cause this life is fast and is not enough. We will have … I remember in San Diego where I met Wayne Dyer. Wayne Dyer the writer. He went to the seminar in San Diego and he said very special things for our souls too.
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Howard Farran:
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So I found Dentistry’s Future: A prescription for success, John Wilde. And then I found the second one.
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Eduardo Ricco:
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Have a look in New York for PennWell. There’s no more PennWell?
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Howard Farran:
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Yeah PennWell stands for Pennsylvania Oil Wells, and it was their first magazine.
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Eduardo Ricco:
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Dental Economics is from PennWell.
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Howard Farran:
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Yeah they own, I think they own 86 different magazines. They started with Pennsylvania Oil and Gas, and then eventually got into ... One of their 86 magazines I think was Dental Economics, and their website’s Dentistry IQ. I used to love the editor of that magazine for so many years, it was Joe Blaze. He’s a great guy. And now it’s Joshua Austin, I think it’s Joshua Austin who I’ve had on the podcast, he’s a great guy too. The internet has really been a game changer, hasn’t it?
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Eduardo Ricco:
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Yeah, it changed our lives.
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Howard Farran:
|
Instead of thinking of a foreign country on the other side of the world in a different continent, now we’re all on google. I think it’s going to absolutely be our finest century. Last century 1900 to 2000 there were two world wars, there was a depression, there was a lot of little proxy wars that caused a lot of carnage, and from 2000 to 2100 is looking so ... This is 2017. If you were to go back to the first 17 years of the last century, you had the Spanish Influenza, which killed 5% of the entire planet from Kansas, to Brazil, to Nepal. We already skipped the Spanish Influenza.
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People are all worried about all these problems, but do you know where Howard Goldstein lives in Pennsylvania, Philadelphia bought their first steam engine during the Spanish Influenza because they could not dig the graves fast enough, and the fire trucks were carried by horses. When someone died in your house you were supposed to lay them by the street, and every day the carriage would come by and pick up all the dead bodies and then they would take them out and they’d have to bury them. They couldn’t dig fast enough, so they bought a steam engine to dig these mass graves. Just in that first 17 years of 2000 just not having-
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Eduardo Ricco:
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Was just yesterday, yeah.
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Howard Farran:
|
Just not having a global epidemic, and the right around, what was it? 2018? And then you have the outbreak of World War I, where you know. I think the two world wars killed 138 million people. But most people think the last century was the greatest century ever. We landed on the moon, radio, television, the internet, the automobile. Just think of all the great things.
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Eduardo Ricco:
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Smart phones.
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Howard Farran:
|
That was when 80% of the planet could not read or write, but now with the smart phone and the internet, the next century, pretty much everyone is going to be literate. Everyone is going to have access to information, not just people in rich countries, and right now because of the internet information is free. Information has zero cost. You can go on Wikipedia and it’s 52 million pages long, for free. It’s going to be our finest century ever. The 2000 to 2100 is going to be probably several times greater than 1900 to 2000.
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And I just want to tell you that that was the fastest hour ever. If you ever want us to create a Brazilian Dentaltown that would be great. I bet Neodent, I bet they have all the emails to all the dentists in Brazil. I’m imagine they’re ... Henry Schein might have a lot of them also. I can’t wait to see you and Monica and your three kids in Sao Paulo again someday.
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Eduardo Ricco:
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Yeah, we worked for next congress in Sao Paulo and bring you, okay?
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Howard Farran:
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Okay, I hope you have a great day. Give your family my love.
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Eduardo Ricco:
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Okay, thank you, nice to be with you.
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