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VIDEO - DUwHF #775 - Cole Brenny
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AUDIO - DUwHF #775 - Cole Brenny
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Dr. Cole Brenny is the founder of practicingdentist.com as well owner of Ivory Dental Group in Minneapolis, Minnesota. One of his passion is coaching young dentists around the country to master private practice dentistry, learn the business of dentistry and build, buy and grow practices that they love.
www.PracticingDentist.com
Howard: It is just a huge honor for me today to be podcast interviewing Cole Brenny with practicingdentist.com as well as the owner of Ivory Dental Group in Minneapolis, Minnesota. One of his passions is coaching young dentists around the country to master private practice dentistry, learn the business of dentistry and build, buy and grow practices that they love. You're a young guy. You're 33?
Cole: I'm 33, yep.
Howard: You're 33. I'm 30 years out of school, so your closer more connected to the young kids that are just coming out of school, the first five years. What percent of them do you think say, I don't want to work that hard and open my own business, I just want to be employed my whole life versus how many of them do you think still have a dream that one day they will own their own?
Cole: Well, here's the thing. I mean I love dental ownership practices. My dad is a dentist and he taught me the value of being your own boss, but I'm millennial dentist too, so I see ... I'm definitely part of the unique landscape and problems that we face. I think to answer your question, it's more so that young dentists don't know what they want to do. I think we get out ... Dental school doesn't really set us up for private practice ownership success, so we get out and we've got a ton of debt. Nobody is going to hire us as new dentists because we haven't gotten any specialty training. We have zero experience and then, we're thrown out into the world. The only body that hires us are corporate dental offices, so we work there for a while. Then, many of us don't every, every experience a quality private practice. It becomes the less scary thing just to say status quo.
That's my take of the current state of things, but I think there's a lot of young dentists that want to be practice owners and that's a dream. That's my dream and hope for most all young dentists, but yeah, it's hard. You get out and you never do molar endo because they get sent out. You never really get to do any ortho. You don't get to do any surgery. You get stuck for five, six, seven, eight years at corporate and then it's just easier to stay there because you forgot what private practice was ever like or you never experienced it all, so it's interesting. That's a good question.
Howard: You know a lot of my friends from class of '87 UMKC, we talk about how when we were in school there were six full-time endodontic instructors and now some of these dental schools are bigger and they only have one.
Cole: Yeah, it's crazy. I mean we did, I think ... When I went back to teach ... I stopped once I started practicing, then I started a couple of years ago. I was teaching for about four or five years. When I graduated, it was good if you did one molar endo. I mean you got out, you did one molar endo, maybe you did a couple of surgical extractions. That's the problem. I love U of M, it's a great school, but for a general dentist, which I am a super big advocate for, practice owner, dental school right now ... And that's why I do this. That's why I teach. That's why I built practicing dentists is to help new dentists and new potential owners at least bridge the gap or make it less scary. Have someone come alongside them and be a resource so they can actually get the questions answered that they need to because, yeah, the trajectory is less practice ownership and more corporate, which isn't bad if that's what you want.
Howard: And you know that's what corporate is doing so well. I think it's funny how so many dentists complain about corporate, yet their office sits there 168 hours a week and they're only open 32 hours a week. Their phone is ringing off the wall when they are closed Friday, Saturday, Sunday evenings and they don't hire any of these kids. They could hire them and mentor them and do all this stuff. They don't want to do any of that, but gosh darn when corporate rolls into town and hires all these kids, all they'll do is complain and whine about that.
Cole: It's interesting because I totally get that. We're downtown and we have corporate all around us, but it's not ... Honestly, I see them as two different entities and I think I've heard you say that too. It's like if you set your practice up right, you're a completely different flavor option for your patients than a corporate practice would be, but you just have to see how that executed I guess.
Howard: When did you start your podcast and you're uploading that on the Dentaltown App, so if you're commuting to work and ... I started podcasting, I think this is like the 800th day, like 800 days ago, because we needed to start that section on Dentaltown, but Dentaltown is Dentaltown, it's not Howard Farran. It's a user generated content site and I'm so excited now there's 39 people in dentistry uploading podcasts, so if you're driving to work open up that Dentaltown App and you can see ... You go to Dentaltown and then on the lower right hand column is these three horizontal bars and it says more and then there's podcast. When did you start podcasting and tell us about that journey?
Cole: Yeah, so I'm a millennial dentist, so that means technology is pretty integrated into my whole life, in our whole lives. When I started teaching the whole idea was keep thing short and sweet, short videos, things you can download, relevant topics that are specific to the problems new dentists and new practice owners face. Podcast just kind of evolved as I did that because I do ... Most of my teaching is short videos and simple downloadable guides. Podcasts are nice because I can involve other experts, other dentists. The podcast is called The Dental CEO Podcast, Dentistry in the Real World. The whole point of it is just to interview other dentists or experts to have just real world conversations. The whole thing with this podcast, I started doing it maybe a year ago just because there was a demand for it and it's a fun way to involve more people in teaching. It just took off. I think everyone is listening to them, especially young dentists, dental students, new dentists. Like you said, going to work, pop in your earbuds and listen to somebody or listen to a conversation about maybe something that you don't know quite well. I love it. Podcasts are super fun and super easy.
Howard: What is the exact name of the show?
Cole: It's called The Dental CEO Podcast, Dentistry in the Real World.
Howard: And you can also get to it from your ... If you go to practicingdentist.com, there's a button there where you can click.
Cole: Right. I've got the podcasts right online or it's on Itunes too, so apparently ... I had comments you got to post on Itunes because apparently people love Itunes and can download it easily there. Yeah, it's fun.
Howard: Right, Apple is a big, big, big player. How are you teaching these dentists to thrive in private practice? How I that going and how do you do it?
Cole: Yeah, so there's two different ways. Basically, Practicing dentists is built on two avenues. One is new dentists, so dentists that are just graduating dental school or just entering private practice, so a lot of that is ... I've got a CEE guide I do every year for example. I mean a lot of it ... I build this content off of people, dentists that have been out five, ten years, one year that report back and I ask, "Hey, guys what are the things you wish you would have been taught?" And I will put together some content and training material on those questions.
One is for new dentists. I do a course actually too. Every year we do a couple of events around dental schools around the country. We do a ... I call it The Welcome to the Real World Course. It's a lecture just about a lot of questions and things that you're going to facet in first year or two that nobody maybe told you about. It's pretty fun. It's pretty exciting, I think, a lot of the new dentists love it. We do that here in Minnesota and we've got one in Iowa next year and Marquette, UMKC and Nebraska.
Part two are dentists who are thinking about ownership, because I love ownership, huge advocate. The idea is to come on one-on-one and help them navigate, the mistakes to avoid, how to set the practice up to be successful from day one, how to market it, how to build it and how to put together your team. It's just a simple one-on-one to help you get launched. I call it Practice Launch Coaching and it's just ... It's inexpensive. I do it because I love it. Just to come alongside somebody and have another ... Hear a voice, because I know when we go out and we start practices, we start buying these boomer practices and then have to switch them over and add some technology and revamp them and change them around. It's unique and we have no prior experience on that. It helps to have someone put it together.
Howard: Most of your students, are they still in dental school or are they a couple years out as an associate somewhere?
Cole: Graduated dental students, so I'd say dentists just graduating, so one to five or six years out are most of our listeners. Every year we build more and more that come out of dental school, then they stayed tuned. We have a Facebook Mastermind Group, which is really fund. It's the dentists that graduate and then we get together on Facebook and it's like a chat room. You can talk and ask questions and send cases. It's really relevant to the problems facing people one to five years out. We talk and when they are ready to do practice ownership we kind of move on there. Basically, it's that scope or that trajectory and then go and become an owner.
Howard: And what do you think the biggest barriers or biggest things they're learning that make them go from associate to owner? [crosstalk 00:09:56]
Cole: Like what are the challenges?
Howard: What are the challenges? What do you think they're learning from you the most to make them pull the trigger?
Cole: Yeah, I mean when I work or talk to new dentists it's ... We do some events here in Minneapolis too for potential owners just to help them bridge the gap and kind of get questions answered because I think it's fear. There's a lot of fear around just the unknown. You're working, like I said, in a corporate office. You have no experience with the business of dentistry or how to run and manage a practice because you've been working for corporate and it's hard to take the lead. Or you look at the debt and you worry, oh, how are the numbers going to work out because nobody has ever taught me about what the numbers look like. You get an appraisal back and you're wondering well, is this a good option or not, is this really right for me and what I dream for my career or not. I think fear is a big, is the biggest roadblock, the biggest barrier from people taking the lead.
Howard: Fear, definitely fear. Do you recommend building a denovo from scratch or do you think or do you counsel that they should buy existing?
Cole: I mean, I think it depends. Personally, I built my office. I did kind of a unique thing. I think ... There's an interesting option happening now more and more with boomer practices coming online because I think there a pretty good supply here in the next 10 years as people that have delayed retirement are going to decide to retire and just ... My dad was a dentist, in 1980 he had 150 in his class, I graduated with 100, so in Minnesota there are 50 retiring dentists now for every 100 coming back. The problem is a lot of those now are working in corporate, so there's less people to buy them. I think ... I have had friends, I have had colleagues and [inaudible 00:11:43] workers that have started great from scratch offices and loved it. Personally, I think there is definitely a business advantage to acquiring practices and rolling them in. You could do ... What I did was we actually acquired a couple of practices and then we built an office from scratch and simultaneously combine them, which is very difficult, but it work really well, but is very tricky. That was a great option and so, now we're still just acquiring more and more practices, which is great, a great way to grow. The business numbers point to if you can buy a practice and make it run, make it fly it's easier in lot of ways.
Howard: It's easier and safer.
Cole: And safer for sure. I mean there's a lot of risk to start up.
Howard: Yeah and some of those people when they got $300,000, $400,000 or $500,000 in student loans they need to actually buy a bigger practice, so they can get that debt paid off in 10 years.
Cole: Right.
Howard: I mean if they start small or they'll say well, I have $350,000 in debt so I'm only going to buy this little practice for $450,000. It's like well, dude if you got $350,000 in student loans you need to buy a million dollar practice, so you can have massive inflow.
People listening to the podcast are usually driving, so what I do with my guest is I retweet their last Tweet. I am @HowardFarran and you're @practicingdent on Twitter, but you haven't tweeted, so I can't retweet it. You're listed at practicingdent. If you make a tweet today, I'll retweet is to the dentists, because then they'll just go there and then they can go right to your website.
Cole: I'll do it. Yeah, no, for sure, for sure. I'm interested. You're talking about opening a practice versus buying a practice. I think one of the things that I see that is interesting is with so much debt too, people got out and they are really worried about the price of a practice and the size. It's funny because there's a phenomenon or dynamic where it's like well, if I buy something cheaper it's going to be better and it's exactly off your point, which said that necessarily isn't the right say to think because the practice, if it's a good practice does the price really matter that much? I mean I think there's more important things to worry about like the size of cashflow and the revenue it's generating, right? The new patient flow, so it's interesting. I don't know if you've talked to people about that or heard that before, but I've kind of seen that now with a lot of new dentists.
Howard: Yeah, and I ... There's a lot of new technology, like a lot of these practice brokers their main goal is to sell the practice. You can go in there ... There's so many dashboards, there's so many dashboards that you can install and find out all the metrics of value. It doesn't take mad skill, I saw a kid really fail big in my backyard. I bought like a million dollar practice, but the guy was a really high-end cosmetic dentist and he thought he could do all those veneers and crowns, which he could, but he sure as hell couldn't see it. He bought like a 1.2 million practice and I mean he had that thing under $600,000 in year one just because he didn't realize the selling doctor was just a master treatment plan presenter in selling dentistry. Also, there is also a lot of hidden value in those practices. Like if you buy a practice and he's referring out a molar every week to an endodontist. There's $50,000 revenue if you can do molar endo or maybe he never passed implants or he didn't do Invisalign, but you really got to match the skill set.
Cole: Right, but yeah, I like that. Unlocking the value.
Howard: And you also have to make quick decisions because like you say when there's 50 dentists retiring from 40 years ago and the graduating class is now 100, it's totally a sellers market. When these people put up a practice for sale in the urban areas, they're getting three or four offers that day, some are above the asking price. If you're a doctor paralysis by analysis where you just want to sit there and think about it and talk to all your friends and just dwell on it, by the time you are ready to pull the trigger it's gone.
Cole: Right, we saw that personally, actually. I have a good friend who we were working with and yeah, it came online and we were dealing with the financing and looking at the numbers and back and forth and back and forth and boom, it sold. He was really bummed. It's like the housing market now. I know in Minneapolis, I'm sure Arizona is similar, it's like a house comes on the market and you're in the city and if you aren't sure of what you want, which is a good ... I guess the moral of the story is know your goals. Have a plan for your life or your career and be ready to pull the trigger, right? When something comes online you need to know if it's what you want or not and be ready. That's something definitely I think that would help a lot of dentists.
Howard: Who are these other dentists on your ... If you go topracticingdentist.com, there is a Dr. Lam Tu, Minnesota Career Plan Coaching, Dr. Preston Hamrick, Practice Coaching Lite, Dr. Katie Daniels, who are all these people?
Cole: Yeah, so those are clients. Those are Practicingdentist clients. People I have helped through the coaching program, so not the new dentist program, that's all usually sponsored or free content, but the coaching is one-on-one. It's really fun for me because it's kind of hey, let's meet one-on-one, let's lay out your plan, help you develop the steps to take to get to where you want to be and it's really customized and specific. It goes from as simple as developing a career plan to as in depth as full practice launch coaching, which is what we do with Katie. Actually, I just got off the phone with her today. She bought the practice. We took her through finding it to buying it to launching it to hiring and now we're doing some marketing coaching just to help her become a growth practice basically. It's super fun. It's the whole spectrum.
Howard: Are you getting a lot of ... How are you coaching on technology? Some people look at an office ... They want to buy an office. They're bummed out because maybe the equipment is old or its got a Pano or it doesn't have this or that. Do you think any of these ... When you're analyzing a practice and you're growing ... You buy a practice and you start growing it, is there any technologies that you think are a return on investment?
Cole: Yeah, I mean we definitely look at it as kind of like level one, level two, level three. Kind of what I teach or preach is scaling up, so I think as new dentists if you can buy a practice with great numbers and a great location that has potential opportunity, you know that's a restart. Then, from there, you look at it and you say well, we've got a ton of debt let's be smart about it and scale the practice as you grow. There's certain things we need to invest in right away to create growth, but the rest are kind of icing on the cake, things that you add that then help you gain momentum. As more dentists are buying practices, we're seeing no digital radiographs, that's a simple no-brainer. Online or not online, I'm sorry, digital charting, digital practice management systems. Two big things that we are doing right away. I mean those two biggest ROI and then even patient management systems we're seeing some good feedback on, things like Lighthouse and Demand Force, just being able to communicate and fill those hygiene holes with technology and getting ROI back, exactly what you said, is really key. I mean digital radiographs, practice management software that's a no-brainer for sure. The other add-ons like you said can wait.
Howard: Okay, you said digital all radiographs, you said that's a no-brainer. As far as practice management software what do you think ... Which one do you recommend?
Cole: I mean there's a lot of them out there. We've used Open Dental. We've used Easy Dental and Dentrix. We've worked with Shine, Patterson Dental. Honestly, I don't think it really matters that much. I think it's kind of like what do you like to use? They all do the same thing. I mean they manage your practice. What are you comfortable with? What's efficient and cost effective for you? I wouldn't worry about it too much.
Howard: You're agnostic on software. Are you agnostic on which digital x-ray system?
Cole: Yeah, yeah, same thing. I mean at this point the technology.
Howard: You called out names. You did like Lighthouse and Demand Force. Explain to people who don't know what is, what that is?
Cole: Patient management software is like an add-on that integrates to your office and your practice management software. Basically, it kind of feeds off of all the digital data in your practice management software, so that you can communicate with your patient. We use Lighthouse. I like it. I'm happy with it. It does whatever we need to do with it. There is other interesting programs. I just met with the guys from Weave, which is a really interesting software program and it also integrates with your phone and basically if someone calls, it pops up their name, integrates with your chart. It tells you if they have an unscheduled appointment, if their family has an unscheduled appointment. It tells you if they are past due on their re-care. It tells you when to call them. If they are six months out it sends them an automatic text reminder or email reminder. It's a simple tool, but we've seen a ton of value in it. I think in our practice, it's been really important because again text message going to a patient. The number one thing they are going to look at ... The number one tool to communicate right now is text message. That's for sure.
Howard: Yeah, email is yesterday. They say 50% of emails got into your SPAM filter anyway.
Cole: Yeah, it just get buried.
Howard: If you are driving, you mentioned Lighthouse 360, they are at Lighthouse PMG. Lighthouse makes it easy for local business to grow and manage profitable customer relationship through a number ... Is it Lighthouse 360?
Cole: Lighthouse 360, yeah.
Howard: It looks like they are in different verticals, because it looks like it's not specific to dental anymore.
Cole: They probably ... It used to be pretty specific. I mean Demand Force is the one that's the least ... I think they have a lot of different verticals, but Lighthouse was and they are pretty ... I mean pretty specific in terms of what they offer.
Howard: Okay, so I retweeted ... If you are driving in your car, I retweeted the Lighthouse and talk about the difference between Lighthouse and then talk about Demand Force, then Weave.
Cole: Yeah, Demand Force is similar, they're both similar. I mean honestly these things do the same thing. They communicate to your patients. They gave you a dashboard where you can look up who's due, who's past due. It can send out newsletters, you can do email, you can do targeted mass messages. It can do auto-fill, which is really nice. It's a new tool we had with Lighthouse this last month where if you have a cancellation, you can actually do ... It somehow notices that open gap in your hygiene and you can hit a button and it auto texts 10, I think 10 or so patients to see, who are past due, to see if they will fill that and all they have to do is click see and they're put back in the schedule. That's been the bain for a lot of dentists, I think is unfilled hygiene slots or last minute cancellations. That, in itself, I think has paid for the month fee.
Howard: What is the average fee for Lighthouse, Demand Force or Weave?
Cole: I would say it's like $299 to $499 a month usually is what I've seen is common. Weave is interesting. I just met with them. It's interesting. I haven't used it, but when I talked to them the interesting thing is their phone system. It's basically like if you are updating your phone system and you don't have a patient management system, it basically is a two in one. The phones, the patient management system, they all integrate together as one kind of monthly service. They had some really cool interesting features with their phone system. It's like if people call it somehow knows the family members that have unscheduled appointments or treatments leftover, so as they call on the phone it pops it up on your computer on a little bar so you can, when they call, say, hey oh by the way did little Johnny come in? He still has got that one little filling we need to take care of. Those systems are great to have in your practice whether you have a computerized system or not, but it just makes it easier and faster. That's the thing with technology.
Howard: Their Twitter is Getweave. I always forget that.
Cole: Getweave, okay.
Howard: Getweave.
Cole: Yeah, they're interesting, an interesting solution. Do you guys use anything?
Howard: We're scheduled for July 4th ... I've been on Soft Dent sinc 1987, so 30 years I've been on Soft Dent and that was the big kahuna back in the day. We're switching July 4th to Open Dental.
Cole: Open Dental is nice.
Howard: Because on Dentaltown it seems like Open Dental users are raving fans on Dentaltown. I just see it. They're growing so fast. I think they are the only ones that don't even advertise. You don't see them advertised anywhere. I think it's a ... We're going to do that, then we'll add stuff onto it. Because it is an open system, whenever I'm traveling around the country and I'll go to like call centers where if it rolls over the third or fourth ring it will go to a call center. Everybody just says that Open Dental ... I mean the whole deal was that it would open and integrate easier. It's just so much easier for all those other ... For that software system to integrate stuff to.
Cole: Yeah, everything else to integrate in.
Howard: Integrators tell me that story every time. Call centers all say it. In fact, some call centers are some big name companies and when they find ... When a call comes in on that, the first thing, when the phone rings, they yell a profanity word because it's just ... That's was Jordan Sparks. That was the whole deal. The whole deal was he had one of the big two and he was trying to export his patients names and addresses and all that stuff so he could do a direct mail piece and he found out that not only he couldn't do it, but they had actually gone to great lengths to make sure that he couldn't do it. He thought why are you paying people to lock down my data, you know what I mean?
Cole: Right, oh yeah, for sure.
Howard: He was so pissed off he started Open Dental. Now, his brother, Nathan, runs it. Okay, so when you're talking technology for Lighthouse, Demand Force, Weave, any other technologies to help with the business of dentistry?
Cole: You know the phone systems are interesting. Digital phone system, things that you can program. The automatic voice mail and voice response and definitely roll over. I mean there are some cool phone options out there. I mean ours is simple, digital phone. It rolls over. We get is answered.
Howard: Is there any big brand that you recommend?
Cole: No, not that I have seen. What we use works well. Weave is really intriguing to me and that might be something we'll make a move on in the next couple of years as I see it play out. The interesting thing, technology that's inside at all practice. I guess outside in marketing for dental marketing I think the website. A dental website is just like ... It's like low hanging fruit. That's one thing I coach whenever I work with clients it's like your website is number one. Invest in a great website. Get something built that's user friendly and nice and unique. I mean I think it's so easy to make a great website and it converts so many patients if you do it right. Just investing a little bit in your online presence, your reviews, maybe your Facebook presence just to help express or live tour or show your culture is a great way to go. That's just, like I said, low hanging fruit. That's like a no-brainer, got to do it.
Howard: I enjoyed your podcast, episode 58 on Dennis Matrix. Is he part of your team? Your episode 58 recreating the patient's experience with Dr. Cole Brenny. Do you work with Dennis Matrix too?
Cole: Well, he's one of the online educators I think in dentistry right now too. We're all kind of connected to some to degree, you know hi and you and Anesia Holmes and Mark Costas and people like that. We're connected because we just ... We're speaking of the same people and we're peaking the same message. We're just trying to help and encourage dentists and get them some great content and connections. Yeah, that's a good one. I like that one. He's a good guy.
Howard: What about technology to do dentistry? You talked a lot about technology running a dental office and digital radiography. What about ... All that stuff is for the dry hands up front.
Cole: Yeah, right.
Howard: What about the wet hands in the back?
Cole: For the wet hands, that's a good question. I love ... There's a couple of things that my partner and I at Ivory, we have invested and just loved. I learned implant dentistry soon after dental school. I was mentored or I learned from Carl Misch. I did his surgical training course and loved him, great guy. I think the implant systems are super easy. I think getting good training ... If you have a good surgical background, surgical training, get an implant system, it's awesome. Then, also endo, my rotary endo and my GuttaCore, I love it. It's like ... We do endos all week long. My partner and I come back to the office and it's like that was really enjoyable. I used to hate endo, but it makes it so much more predictable and efficient. It's just super, super nice.
Howard: Which endo system are you using?
Cole: We work with Dentsly, so we use their Wave One System. We just changed over last year. WaveOne GuttaCore. The WaveOne GuttaCore combo is like ... I mean we don't have failures. We don't have breakage. They are predictable. They are fast. It's clean. The patient does to have a lot of postop pain. It's like ... I'm making it sound better than it is and I do not get paid from Dentsly, but I love it. It's like the one product we look at specific.
Howard: What did you switch from when you switched to Dentsly WaveOne GuttaCore?
Cole: Well, my partner he was working ... He was hand filing. I've worked with a GT.
Howard: Wow.
Cole: Yeah, he was hand filing. My dad still hand files. He refuses. He won't do it. He won't change.
Howard: Really?
Cole: I don't know. He's old school. He up in central Minnesota, but he loves it and he's good at it, so he does it. We were using the GT files, the Protapers too before this or I was, but the WaveOne I just ... I love it. WaveOne Gold is what we use now. It's not cheap and that's the drawback. You kind of look at it and you're wondering that's the question to answer how much do lean towards the generic brand things to save some money and then how much is it worth it just to get something that works that's worth it that can do things predictably and is quality. It's not cheap, but it works really well. Are you looking it up?
Howard: No, no, they were Dentaltown Townie Choice for last year's readers of Dentaltown, a publication dedicated to aiding clinicians and practicing high quality dentistry voted in throngs for their favorite products to help them practice better and safer, blah, blah, blah, blah. Our heartfelt thanks to all the customers who voted for these guys. Yeah, if you're not aware of the Townie Choice Award, there's a section on Dentaltown, every year we have thousands of dentists vote for their favorite products. Dentists have eight, 10, 12 years of college. They're very anal. They're very paralysis by analysis. They don't make quick decisions. If you're getting beat up on a product, you might want to go look at which product one. We also don't just show the winners. We actually show the math. We show the voting.
Cole: That's a great tool. I use it every year. That thing is awesome. The other practice metrics that you put out, what is that? It's like your yearly summary of practice, state of practice. That's a great one too just showing number of days works, revenues and things like that just to see a ball park of where other dentists are at. It's awesome.
Howard: And I remember when we first started doing it, there might be a material that you are really having a lot of problems with and then you look at the voting and you're like okay, this one won with 1000 votes and number two was 500 votes and then number nine only had 3 votes and that's the one you're using. Then, you have to start asking yourself how come a thousand people became a doctor and you are one of only three out of 1000 using this product. Then, some of the stuff, the winners it doesn't matter because ... Like every year on loops, the battle is as bloodbath because it's almost a perfect 50/50 tie, so the winner will be like 50.3 and the loser will be like 49.7. It's tough when you don't win the Townie Choice Award by three votes. Then, you sit there and say, well, looks like my homies are split 50/50 between these two brands. I try to do it so that you can make faster, easier, quicker decisions.
Back to endo, you know a lot of times when you are thinking about the overhead of endo, I mean if whatever you are doing makes you hate it and then you don't do it, then ... You don't like lateral hand filing and you don't like lateral condensation, you like engine driven and you like those GuttaCores, right?
Cole: I love it, I love it and I do it.
Howard: Not many people say, "God, I love endo."
Cole: I know, it's crazy and I didn't love it.
Howard: If you buy WaveOne and you start using GuttaCore and now endo is tolerable or acceptable or makes you love it, well, my God the patient wins. They don't want to be referred out different places and you are rural they're not going to drive into town.
Cole: Win, win. It's increased revenue. Your patients are happy. You are taking care of them well. If you're not busy and you are worried about getting more patients, well just add ... Get good at endo and add endo, that's going to fill a two hour or an hour and half block in your schedule. It's something that you would have sent out otherwise. Yeah, I think I saw you write something about that. You called endo the low hanging fruit, like a no-brainer, like learn how to do it and do something, do some of it.
Howard: Well, some of the things that millennials do that seems kind of strange is they're always whining about there are $350,000 in student loans. They're just always whinging about that. Then, you see them two years later at a study club and you go, "Well, how are you doing?" They're all excited and they are like, oh, we just bought a house in Chandler. I say, "How much was the house?" And, they were like,"It was $400, we got a good deal." So, $350,000 in student loans to be a doctor, you are about ready to jump out the window, but now $400 to buy a house and I'm sitting there thinking why did you buy a house for $400 if you got $350,000 in student loans? Why didn't you buy a starter house or live with your parents or stay in an apartment or stay mean and lean? It's not what you make, it's what you consume. Why didn't you keep your costs down? Then, a lot of them will come out of school and say well, I just don't like endo.
I mean when you look back at our family tree how many of our parents and grandparents did things they hated for 40 years to put food on the table? I mean I don't remember a lot of farmers in Kansas saying, "Yeah, I like working sun up to sundown seven days a week from age 16 until I drop dead." Then, they are sitting there, "I don't like endo, so I won't do it." Well, it's like you know what? Have you ever thought about maybe you should do shit you don't like because the patient is in pain and you need the revenue and insurance pays 80% of it. Just because you don't like something doesn't mean that you don't do it or you take so many courses and you get so damn good it at that you love it. Maybe if you did 1000 molars you'd love it.
Cole: Yeah, I mean I think ... To answer your question or go alongside that, I think as new dentists too I think you're right controlling cost is important. Humbling yourself and stepping out, doing whatever it takes to build your practice is kind of what we need to do and part of that means, like you said, helping patients where they are it. If they come with an endo, you can do it. Start doing endo. I do ... I still do some prophies. I mean I have ... I've built my practice where I had openings and my hygiene was full and I would say, hey, put a prophy in my schedule. I'm not above getting someone in to help them out and they didn't have to wait two months to get in.
Howard: A lot of dentists that hire these associates will say ... They'll have a cancellation or no show. Someone will call in and want a cleaning and the associate is like well, I'm not going to do a cleaning. I'm a doctor. It's like where does that come from?
Cole: No, that's common, yeah. I don't know. That is weird. I've heard that too.
Howard: And the cultures of it, like in Phoenix, Arizona, when you graduate from med school you'll usually work two 24-hour shifts in a hospital, like you'll work Monday from 6 a.m. all the way to 6 a.m. the next day, then you come back Thursday and work 6 a.m. to 6 a.m. the next day. Then, you ask an associates it's all whining about their $350,000 student loans. Oh, yes, yes, whining. You'll say, hey, we got an emergency and they can come down here right when we close at 5 and one of the dental assistants will stay with you. Well, I'm not staying late. I mean I got stuff to do. I got to meet my husband for sushi and drinks and [inaudible 00:37:58] and then asking them to work one Saturday a month. It's like you're asking them to climb Mount Kilimanjaro barefoot, like Saturday? It's like come on man if you ... Every hospital in America is open Christmas, Easter and Hanukkah.
Cole: Yeah, it's very unique people.
Howard: Yeah, yeah, if you are going to have a pity party about $350,000 of debt, maybe you should just hustle. Maybe you should just work as hard as your grandpa did. I mean think about those stories you hear of your grandma and grandpa back on the farm. I mean Minnesota winters, what was that like 100 years ago?
Cole: Yeah, uphill both ways. There was a blizzard every day.
Howard: Yeah, so there's just something to be said ... I can always spot the success when they come out of dental school just because they hustle. They've got a work ethic.
Cole: Yeah, I mean you're talking about a really complex issue. It's easy to hate on the millennials and point everything out. Every generation had their thing. I'm sure when you came out, right, your parents were like the Woodstock hippies, right?
Howard: Yeah.
Cole: The 60s, the same thing. Maybe it's the same thing, different story, but it's like ... Yeah, I think you've got to get it, you got to work hard and you've got to have goals. You've got to have a plan. I think that's the big thing. Yeah, get out, work hard, help the patient. You can definitely differentiate yourself from corporate by really focusing on delivering great customer service and quality care, so that means yeah, be able to do everything. Have your hours be convenient. Get the patient in when they want to get in. Make it convenient to them and your practice is going to fly, right? If that's what you are whining about then go and do those things, right?
Howard: You just nailed it. The new patient experience it's everything. It's all about how you make those people feel. I can tell you being a dentists 30 years, nobody ever remembers who did what in their mouth. I mean you can point to their only gold crown and you're like who did that gold crown? I don't know. Dude, there's only one gold crown in your mouth. You're telling me ... I said, "Were you ever walking down the sidewalk and all of a sudden you got knocked over from behind, you woke up and saw some man running down the street and you had a new gold crown on your tooth? I mean how did someone get in your mouth and place a gold crown and you have no idea who did it. That was one damn good dentist, I mean talk about."
Cole: Right.
Howard: But, they only remember how you make them feel. Some of those offices, every one of those touch points from answering the phone, thank you for calling Today's Dental, this is Valerie. How may I help you? Then, how they make them feel when they come in as opposed to sliding open the door, handing them the sign in sheet, not making eye contact. You can just smell these dentist offices. They feel like a library and they smell like Eugenol and no one ever comes back. Then, you walk into the next one and you just walk in and you just feel a connection. You just feel dopamine and serotonin and oxytocin and those are the ones that crush it. The same thing with dental school graduates, some of those dental school graduates you meet and they have that whole library thing going. Then, you meet these other dentists and they've got the warm, touchy charisma, whatever and those guys just crush it and it really doesn't come down ... That just is such a huge important factor to the whole equation.
Cole: I mean I think too, you have to realize like too, when you graduate from dental school there's a spot for a lot of those dentists that are the Eugenol, not going to push hard because they are going to go to corporate. They are going to go somewhere and they are going to be happy and content. They are going to stay there and everything is going to be safe. It's going to be laid out every day. Someone else is going to take care of the business, which is fine. I mean some dentists that's what they love, so I guess I can't hate on that because some people, that's what they want. I guess if that's what you want good for you, but yeah, if you want to be a practice owner and, which you just said is pure wisdom, you can differentiate yourself very easily by investing in that patient experience. That's why that podcast with Johnathan was great. I got a ton of feedback about that because it's something that you're not taught in dental school.
It's the way to make your practice fly and it's about recreating that experience from the point they walk in til when they leave. How did your practice feel? What does it look like? What does it smell like? Do you remember your patients? What are they going to say about you when you leave? Are you special, you know? You have to be unique and special because if you're not ... I think I read something, 80% of patients think that their offices are all the same. If you can be the 20% in a good way, right? You are going to grow because they are going people over. We see that at Ivory, because that's what we are trying to do and that's what we do is we create that experience. It's working really well and we love our patients. They send more people like themselves, which is the goal, right? You build experience, the patients you want, they send patients that are like them that you like.
Howard: You know you're up there in Minneapolis/St. Paul. My sister is in that area in Lake Elmo for 35 years, but you're right up the street. You're 45 minutes away from Mayo Clinic. I always wonder why so many dentists don't realize the lessons from Mayo, because Mayo attracts people from around the world, so does the Cleveland Clinic. I mean Cleveland Clinic has over a million followers on Twitter. With 5 million followers, you can become the president. It's just huge. It seems like so many dental offices and so many corporates, their whole branding is cleaning, exam and x-ray for $99 or buy two get one free. They're branded as a cheaper, faster, easier commodity.
Cole: Discount.
Howard: Then, the problem with that is when I buy a commodity like a bottled water, I know what I'm buying, but when I walk in there and this Dr. Cole Brenny looks at me and says, "You have four cavities." I don't know if that's true or not. I don't even know what to base that on. Then, I came in because you had this $49 cleaning, exam and x-ray special. Now, you tell me I have four cavities that are $250 each, so it's like oh, okay I get it, I come in for the $50 cleaning and now you tell me I need $1000 worth of cavities. Cleveland Clinic and Mayo Clinic and Sloan and Kettering, and Scripps Hospital in San Diego. I mean it just seems that the boys up the street realize that branding trust that you know if you go in there ... When you are selling Invisible and these people ... I was talking to a dentist the other day and his wife is in Colorado and she was so confused about the healthcare she was getting from her doctor there, they moved back to Cleveland, so she could go back to the Cleveland Clinic. She was like, I'm a retired woman. That's the most important thing.
I know another friend where the spouse wants to retire back to the country he was born in, in Central America and she's like, "I'm not going to Central America, when I'm retiring. It's all about the healthcare system and here's my doctors and I don't want to go to doctors in the country you were born in." I always wonder why with trust being ... Selling the Invisible and trusting being so important I wonder why the dentists don't follow the Mayo Clinic up the street from you. What's you thoughts on the Mayo Clinic?
Cole: I mean I don't know ton about it besides that it has the reputation of being a great hospital. My wife actually worked there for a year, I believe. We actually lived in Rochester for a little bit. It's interesting if we're talking about branding and the May Clinic. The whole culture that they've created. The whole city of Rochester is Mayo Clinic. If you've ever been there it's actually ... It's interesting because it's like 45 to 50 minutes from Minneapolis and you're driving through corn fields and streams and it's like farm country. Then, all of a sudden, boom there's towers and the Mayo Clinic and Rochester is there.
It's a pretty healthy, quality city but everybody works for Mayo and everybody ... There's the stories of people ... My wife used to work ... She's a nurse and she used to work there. She would talk about they have certain suites where the sultans would fly in, right? They would have their golden toilets or whatever. To build that reputation to be so quality and the experience, even to work there as an employee so here's an interesting point tying into that, to work there as an employee. They found the best people and they treated them the best and they stay. People build families, small town Minnesota and they've got a great culture and it's from the bottom up. It's the image, but it's also the infrastructure, right? The people inside of it are the best people, but they love their job. She had a great manager. She was treated really well and then that gets out into the world and people come from Saudi Arabia. That's my experience. That's what we know here.
Howard: They have a branch down here in Scottsdale too.
Cole: Yeah, yeah, they do. I saw that.
Howard: The metro here is about 3.8 million, it's almost 4 million and it's down in the desert so there is so many retired people down here.
Cole: Oh, yeah. I've seen it.
Howard: We call them snowbirds.
Cole: We're snow, I come down twice a year to visit grandma.
Howard: Your grandma ... Where's she at down here?
Cole: She's in Sun City. I'm coming back, I think, December. We come back twice a year. She's 93. She went to the Mayo Clinic last year. I totally get it. I've seen it. I've seen the building there.
Howard: It's kind of funny because so much of those retirement communities you'd think could be unconstitutional to have Sun City, you can't live there if you are under 55.
Cole: Yeah.
Howard: I can't move there because I'm 54, but you would think if you started a business and said you can't have this business unless you are 55 you think there would be some discrimination lawsuits, but they actually love it because it's very, very stressful for them when they are 93 years old and you have teenagers playing basketball in the screen next to you and balls going back in your yard, driving around in the middle of the night, jamming out to the loud music. Those retirement centers, those people ... And they drive golf carts like they are cars.
Cole: Oh, we drive them around. That's what we do when we are there. We go cruising in the golf car. It's pretty fun.
Howard: Does she drive it down the street all the way to the store, the golf cart?
Cole: No, she doesn't drive anymore, but people drive the golf carts everywhere. That's amazing to me. They're cruising to Safeway. I mean they go everywhere, to the rec center.
Howard: They're amazing.
Cole: I love it down there, so, hey Arizona here you go.
Howard: Yeah. What about other technology for the wet hands? You talk about Densfly WaveOne. Is there any other things?
Cole: Oh, I've got a good one. This is like another no-brainer. I can't even practice ... Well, I have use VPS if I have to, but digital dentistry scanning. Scanning, it's like ... It's the only way to go. I mean I started right out of school doing Zurich and not that I'm strictly a Sirona guy, but it's been what I've used and it's consistent and it's quality for me, but my patients have loved it. The quality is there, scanning and milling, for sure at least scanning is definitely a no-brainer.
Howard: Do you find yourself scanning or scanning and milling?
Cole: I scan ... Well, it depends what I'm making. I have an older unit, so speaking of saving money one of the recommendations I have too for young dentists who are starting their practice ... I bought the Blue CAM used on Ebay and I bought the milling unit used on Ebay. I've had it now for four years and I bought it for $30,000, I think. I can't remember, something significantly less than a new one.
Howard: What would a new one have cost?
Cole: I think at the time they were $90,000.
Howard: Right.
Cole: I mean ... It does ... I could have bought the new Omni Cam at the time, but I wasn't really sold on the updates. It was a flashy new thing, so buying technology like that ... Sometimes if you can get it used, it's a great buy. I paid that off times over now. I use a Blue Cam Zurich milling unit for my single unit crowns. EMAX is great. Occasionally, I'll scan and out for a BruxZir or some sort of Zirconia crown. VPS, I'm still using for bridges or anterior, some cosmetic cases because I haven't upgraded my camera yet, but that's the next thing. We're actually ... My partner and I are talking about the next investment once the full arch scanning and upgrading our scanning unit maybe this next year.
Howard: What do you think you'll upgrade it to?
Cole: Well, we're deciding now. There's Omni CAM. I've heard great things about Itero. I've seen really good feedback about Itero. We just had a meeting with one of the labs. We had a CE event and a pretty big lab here in Minneapolis in the city and we asked him, "Well, what do you see coming back from dentists? What do you like best or what do you see people are using best?" He liked Itero, but he also liked ... What was the other one?
Howard: Trios?
Cole: It was the Trios, yeah.
Howard: Out of Copenhagen.
Cole: He really liked the Trios, yeah.
Howard: You were right, where 3M is, they've got the true definition scanner.
Cole: They do. It's just been ... I looked at it and it's just too clunky for me. The thing that gets me with these scanning units, which I hope we can change someday is the data feed. It's just ... That's the silly thing to me. It's like take a scan and then have to pay your money to email it to somebody. Like you talked about Open Dental and I love Samsung, I love Android, because it's open. You plug something in. I can send things back and forth. Why can't we just do that with these files? That's the thing. Let's buy the tech and just send it. I don't like the gap.
Howard: It's the whole ... I mean there is pros and cons to everything. You can't say this is perfect, like Microsoft is open, but all the hackers know that. Apple is closed and that's why the hackers don't play there. There's pros and cons to everything. What's the name of the big lab in Minneapolis/St. Paul?
Cole: Twin Cities.
Howard: Twin Cities Dental Lab?
Cole: Twin Cities Dental Lab, yeah. That was the lab that I spoke with about this.
Howard: You know that's a profound advice for young kids, hell, all kids. You're sitting there. You're a dentist and you are thinking about buying a scanner. It's just the obvious thing to go down to your lab and talk to the lab man and see. He's getting scans from everyone. I also think for the young kids, I think when you are the first several years out of school, I don't know if you're good enough to put your impression in a box and mail to different city far, far away, because you need a mentor. The fastest way to get really, really good on crown and bridge is when you are talking to the lab man.
I guess with Iphones and Facetime and how we are Skyping or whatever, but when you go down to the lab there's a couple of things that's interesting. This person you are talking to, you might be 24 and the lab man you are talking to maybe he's done this for 24 years and he can show you all the pans coming in and the pros and cons and then a lot of times they can fix you up with a mentor. Like they will say you know, you ought to go visit so and so. Then, they will call them on the phone and say I've got a young dentist here and would you mind if she came by because she's got all these questions about impressions. She is having difficulty taking impressions, blah, blah, blah. Yeah, work you value chain.
Cole: Yeah, when we do our new dentist events part of the topics we cover in the lecture is communicating with your lab or your expert team. One of the things that I talk about is a new density I use my ... I use technology a lot, so when I've had the lab person what I recommend new dentists do is get their name, right? Get their numbers, their cell numbers or get some sort of number and I will actually take pictures of my cases, right?
Every case I'll take a picture with my phone and I have a note phone, so I've got a pen. I can actually take a picture even of the patient and the tooth and I can actually draw right on the screen, right? Then, I email them or I text it, I email it usually to them and the lab will get a picture of what I'm working on. They love that. When a lab can get somebody to send them an actual picture to help out with the case and then give them feedback. Then, we'll go back and forth and they'll say well, what do you think about this? Then, they will show me a picture before they send it back. That sort of communication using this technology we have available now for me has been priceless. It's been great. I think my lab loves it. I mean I may bug them too much, but at least we get it right and I don't send it back, but that's been huge using technology to communicate.
Howard: Now, is that the lab you use?
Cole: That's one of them, yeah, one of them.
Howard: Because people are always looking for labs.
Cole: Yeah, yeah.
Howard: Why do you use them? What labs do you use and why?
Cole: I like them because they are local and I have the guy's name. I know the implant guy. I know my ceramic guy.
Howard: Joel Richardson?
Cole: Removable guy. No, that's not my ... That's not who works on my ... That's not my contact.
Howard: That's the president.
Cole: Yeah, yeah, but I know them. I email them. They know me. They know I'm going to send them an email. I can communicate with them the way I want to communicate. It's helped at times. There's a local guy here who does ceramics, really, really quality ceramic work, kind of specialty ceramic.
Then, I'll also use Glidewell. I like Glidewell for some simple key things. The night guards and bite guards I got back from them, they're solid. They are cheap and they work very well.
Howard: They do 5% of the dental industry crown and bridge, 1 in every 20 crowns is made at Glidewell.
Cole: I believe it, yeah.
Howard: I mean that's just incomprehensible.
Cole: It's crazy.
Howard: One in every 20 crowns.
Cole: Where are they located? Is that California?
Howard: Southern Cal.
Cole: Southern Cal, yeah. Micro Dental too is another big one too, but yeah they're pretty good too.
Howard: I love the CEO, Jim Glidewell. In the last 3 years so many people have taken so many pot shots at the cheap lab, the cheap lab, the cheap lab. It's guys like that who realize that not everybody is rich in America and can do to a dentist that uses lab that costs ... Some of them are 150 a unit, some are 350 a unit and it just seems like whenever you go after the poor in dentistry, you are cheap or you're low quality and he's ... I think he's extremely ... Works very, very hard to make it faster, easier, lower cost. I mean there are lab guys around here that are still at 350 a unit, but they are working with high end prosthodontists and the rich of Scottsdale. There's a market for a Mercedes-Benz.
Cole: You're not going to send your PPO patient to those.
Howard: Yeah, and that's another thing.
Cole: You can't. What do you do?
Howard: Someone will send them a PPO that says sign up for a 40% reduction on your fee. It's like okay, so are you going to do it 40% faster? You can do everything the same. Instead of scheduling an hour and a half for a crown or you going to schedule one hour for a crown? You going to know that whole baby out? See them, numb them, while it's numbing pack the cord, prep it, then make the temporary with your assistant. You can make that 400 temporary in two or three minutes, then impression. While it's impressing with [inaudible 00:58:31] go do a hygiene check, come back, check it with your loops ... Are you going to go faster? Like, on no, I'm still going to block and hour and a half. I'm just going to do it for a 40% lower fee and I'm going to use the same lab that is charging 175 a unit. It's like Dude, if everyone could do that then tomorrow United Airlines would just lower their prices lower than Southwest, who is the number one, 27% of the market. Well, if United just lower their fees to beat Southwest they'd be insolvent in 30, 60, 90 days.
Cole: Right, yeah. Being smart, you have to be tactical in every decision you make, right?
Howard: Is there any CPA that you work with closely on your students?
Cole: Yeah, yeah, exactly. That's one of the things we definitely go through in the steps is just developing, I call it the expert network. That's the thing as a new dentist we get out and we don't know anything about who we should use to help us. It's like we get a recommendation from our supplier, then maybe from somebody else. It is interesting, there's no kind of accountability between the industry people helping dentists. Actually, that's one thing I did in Minnesota, I started doing kind of a ... Almost like your Dentaltown Townie Choice, we do the Expert Network kind of ratings here. I'll put out a guide every year about who the top dental attorney is, the dental CPA, brokers and lenders. Kind of vet them, make sure they are people helping out dentists in the industry and have a good reputation. Yeah, we definitely ... That's important to build that network, so you have those people.
Howard: You have all those contacts?
Cole: Yeah, I do.
Howard: Are those on ... If they go your website practicingdentist.com, is that there or do you want them to email you, DrBrenny@practicingdentist.com?
Cole: If there are any questions, yeah, everyone just go to the website, practicingdentist.com, email me at DrBrenny@practicingdentist.com. That is on ... That guide is online. It's on my new dentist course website, so there's a login to get into that, but yeah if there is a new dentist listening and you didn't get access to that, maybe you missed the RSVP. It's a whole course I built specifically for graduating dental students entering private practice. I've got a book. I've got a guide how to do hygiene in private practice. I've got the expert list if you are in Minnesota, I've got that.
Howard: Is the book on Amazon?
Cole: It is, yeah. It's on Amazon. You can download it for free on my website, so just do that.
Howard: What's the name of the book?
Cole: It's A Dentist's Guide to Life After Dental School.
Howard: Nice.
Cole: Do you see that on the bottom of the practicingdentist site?
Howard: Yes.
Cole: It's on the very bottom. There are two books. There's one, that's for new dentists and then there's Launch, which is Launch by Bill Gross.
Howard: Who's on the cover of that? Whose face it that?
Cole: I don't know. I wish I could make something up, but ...
Howard: That was just a stock image of a model or something?
Cole: Yeah, yeah. I should say it's somebody I know. I should come up with a better story, but yeah that's just a guy.
Howard: That's just a guy.
Cole: We'll call him a dentist trying to start his own practice, Joe.
Howard: That is awesome. Another you could do, you could start thread on ... Dentaltown has 50 categories and one of them is dental students, one is practice management. I would go in there and they would think it was SPAM if you go in there and say hey, go to my site and all of this, but if you start the thread and say I just did a podcast with Howard and he told me to go list this, because these people are commuting. I think it would be great marketing. Under practice manager, there is ask a dental consultant. There's ideas to make your practice grow. Yeah, go the podcast because you have an amazing podcast, everybody should hear it even old guys that need to fix up their practice and get in selling mode, you know what I mean?
Cole: Oh yeah, I mean that's ... Actually part of the time we talk with older dentists who are wondering what younger dentists are going to want. What they should invest in? Well, I appreciate it. I love it. You've got a lot of great info. I've been on Dentaltown since it started. You're a pioneer. It's an honor.
Howard: It's an honor that you came on my show and I love it when other podcasters start uploading their deal. It's all about ... No one reads just one dental magazine. No one listens to one podcast. People think in fear and scare states. I've never met any patient where I was their only dentist and they've never seen anyone else before or after me. I've never met one dentist who only read one magazine or one podcast. It's all about just sharing. It's all about our sovereign profession and I think guys like you are what I call one of the thousand points of light in dentistry.
Cole: Thanks!
Howard: Thank you for all that you do for dentistry. Thanks for starting the practicingdentist.com. Thanks for starting a podcast. I hope you have ... Next time you are down visiting grandma, if you want to come by and have a beer, eat some Mexican food, we'll take grandma out drinking. How old is she?
Cole: She's 93.
Howard: 93, that's a one beer woman.
Cole: She's up for it though. Hey, you better be careful though, I might actually show up on your doorstep you never know.
Howard: Hey, anytime any day brother.
Cole: We'll do it. I'll be back this winter. I'll come bring grandma and the golf cart.
Howard: Okay.