Dentistry Uncensored with Howard Farran

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Dr. Hines was born and raised in a small community in Iowa. He attended University of Iowa for his undergraduate degree in Integrative Physiology and is a graduate of the University of Iowa College of Dentistry, class of 2010. Upon graduation, Dr. Hines became an associate at a large private practice in Toledo, OH. Dr. Hines associated at this practice for 5 years while he refined his skills and learned how to manage a large private practice. 

When Dr. Hines felt he was ready to purchase a practice of his own, he set his sights on Phoenix, AZ where he patiently waited and analyzed available practices. In October 2015, he purchased Dental Care at Moon Valley, a 9-operatory, 3,300 sq ft practice in North central Phoenix. In the short 1 1/2 years of ownership, Dr. Hines has increased collections over 20%, with 2017 projections over 2.1 million. Dr. Hines looks forward to continued growth of his practice and potentially expanding to other parts of the valley. 

Dr. Hines has a passion learning dentistry. He can often be found in study clubs, CE’s across the country, interacting on dentaltown message boards or even at the Townie Meetings!

www.dentalcareatmoonvalley.com

Howard: It is a huge honor to be sitting here on a Friday with Chad Hines. Thank you so much for coming by today.

Chad: Appreciate you having me.

Howard: Dr. Chad Hines was born and raised in a small community in Iowa. He attended University of Iowa for his undergraduate degree in Integrative Physiology and is a graduate of the University of Iowa College of Dentistry, class of 2010. Upon graduation Dr. Hines became an associate at a large private practice in Toledo, Ohio. Did you work with Klinger?

Chad: Klinger? Oh, from M.A.S.H.

Howard: From M.A.S.H.

Chad: Yeah, he is a thing there.

Howard: Dr. Hines associated at this practice for five years while he refined his skills and learned how to manage a large private practice. When Dr. Hines felt he was ready to purchase a practice of his own, he set his sights on Phoenix, Arizona, where he patiently waited and analyzed available practices. In October 2015, he purchased Dental Care at Moon Valley, a nine-operatory, thirty-three hundred square foot practice in North Central Phoenix. In the short one and a half years of ownership, Dr. Hines has increased collections over twenty percent, with 2017 projections over two point one million. Dr. Hines looks forward to continued growth of his practice and potentially expanding to other parts of the Valley. Dr. Hines has a passion for learning dentistry. He can often be found in study clubs, CEs across the country, interacting on Dentaltown message boards or even at the Townie meeting. A big fan of your four hundred and some post. I thought it would really be cool to get some, you know, instead of a fifty-four year old guy talking to a bunch of grandpas. I'm sure a lot of the Millennials commuting to work right now want to hear your story and it's an interesting story.

Chad: Yeah, well, you know, started in Iowa, did all my undergrad at dental school in Iowa.

Howard: Do you know why I love Iowa the most?

Chad: Why's that?

Howard: I went to Creighton and it was in Omaha, Nebraska, and you had to be twenty-one to buy beer in Omaha. So, we crossed that river into - what was the river into Des Moines? No, Council Bluffs.

Chad: Oh, see, I'm from the east side of the States, so.

Howard: So, we just had to cross that river into Council Bluffs, Iowa, and they sold to you at eighteen.

Chad: Okay.

Howard: And, so, if you're an alcoholic, you had to drive across that river, and, but ...

Chad: I like Iowa. I mean, I think I got all my values from Iowa. Unfortunately, my wife is from Ohio and so that's where we headed to after dental school. I found a great practice in Ohio to practice in. Got a ton of great experience. And that's, kind of, really shaped me. From there, you know, as an associate, shaped me where I'm at now. It got me ready to purchase a practice and really, kind of, like I said, refined my skills in terms of a dentist.

Howard: But, talk about why if you're born in Iowa, why did you not want to stay in Iowa? If your wife's from Ohio, why did you not want to stay there? What made you come, literally, a thousand miles to the Phoenix desert?

Chad: Well, a couple things. It was, really, we love Phoenix. We wanted a bigger city that wasn't, you know, traffic-congested, you know, Chicago, New York. However, I wanted a good opportunity, you know. I think that some of the issues some people face is they want to go where it's popular, where it's, you know, you're not going to find a lot of gigs there that, you know, are profitable. And so, I just set my sights on Phoenix. We loved it there. I just waited and waited. Actually, we were looking at a lot of places, but the right opportunity came up here and that's, you know, brought us here.

Howard: And, so, when you came out to school in - what year was that?

Chad: 2010, from dental school.

Howard: 2010. Did you have student loans?

Chad: Yeah. I came from a not a wealthy family, so, I took out pretty much the student loans, you know, for living and tuition, the whole works. So, yeah, I came out with not as sizable as I hear some people are now, but came out with student loans. You know, after about a year as an associate, I started really tackling those, just to get that under control, and obviously that has allowed me to get where I'm at now in terms of paying those down and purchasing a practice, but, yeah, I came out with sizeable student loans.

Howard: So, you came out on in 2010 and you were an associate till 2015.

Chad: Yup, yup.

Howard: And, so, you ... would that be a lot of advice before someone ...

Chad: Oh, absolutely.

Howard: And what were you trying to learn? Your basic dentistry? Basic business?

Chad: Well, there's ... I mean, dentistry is, I mean, it's loaded. I mean, there's so many things to learn. I mean, from, you know, the business aspect to the dentistry aspect. And I always say, you know, I've given a few talks to, you know, some younger dentists and I always say you got to learn to your dentistry first. Don't try to tackle the business end of dentistry at the same time. Oh, you're going to learn business stuff at the same time, but to tackle them both I think would be, in my opinion, a nightmare. I mean, I did an associateship for five years and ...

Howard: In the same place?

Chad: I was in the same ... we had two locations, so I was kind of between two locations, but it's the same owner, same ... basically the same place.

Howard: So, it seems like when you look at ... a lot of people throw corporate dentistry under a bus because of their high associate turnover, but you see the same thing in private practice.

Chad: Yeah, yeah. I mean ...

Howard: Why did ... why do you think you stayed there five ... well, first of all, when you look at your classmates from class of 2010, did most of them get an associateship job and stay there for five years, or are they turning and churning and burning in associateships?

Chad: Yeah, I think it was a mix. There was a couple that went owned in small towns in Iowa which, I think, ownership in a smaller town would be more manageable than in a bigger city. But a lot of them had a few different associateships, you know, usually you hear one to three years is kind of the max associateship. But, you know, I had a pretty good associateship where, you know, I was learning a lot. But after five years I felt I was pretty much ready.

Howard: But why do you think the average associateship ...

Chad: Oh, why?

Howard: I mean, the reason I'm asking is because you're a lot closer, I mean, I'm a grandpa. Do you have any children?

Chad: No, I do not.

Howard: You have no children. I have two grandchildren. Why do you think the average associate is one to three years? Why is private practice and corporate not keeping associates?

Chad: I think there's a variety of reasons. I would probably, you know, say number one is the communication between the owner and the associate. I think they want two different things, you know, and I think they don't communicate those things. I mean, sometimes you'll see owners just want someone to fill the odd hours, Fridays, Saturdays, you name it, and to fill in for vacations. And there are some owners that will want someone there, you know, to produce, you know, and take care of the patients. But, and, I think that a lot of associates, they want to come in and they want to be busy from day one. But a lot of associates don't realize that you've got to earn the trust of the patients. You got ... it is a slow process and some people just, I feel that some people just can't handle that slow process to gain and bill. So, and I think it all comes back to communication and seeing each other eye-to-eye, you know, to know where each other's at in terms of how to get there.

Howard: So, you didn't ... it's kind of funny, you did not buy a little office.

Chad: No.

Howard: You bought a big dog ...

Chad: Yeah, yeah.

Howard: ... and some of these kids coming out of school, I mean, you know, I compare it to a house. So, if I buy a hundred thousand Dollar house, it's gonna be three-bedroom, two-bath, and then when I go to sell it, I'm selling a hundred thousand Dollar house. You could just as easily have bought a two hundred thousand Dollar house, maybe four-bedroom, three-car-garage, you could have ... but I see some of these kids and they'll say, “You know, I don't want to spend a lot of money on a practice. I only want to buy, you know, I'd like to get one for like six fifty.” I mean, dude, you're Mormon, you have three kids at home, you have a stay-at-home wife. You need a lot of money.

Chad: Yeah, you need cash.

Howard: And you're four hundred thousand Dollars in debt. You need to buy a one and a half million Dollar ...

Chad: Absolutely.

Howard: ... big business to ... and, the bigger that office is, the more cash you'll make, the faster you'll pay down your student loans.

Chad: Yeah, yeah.

Howard: And it's kind of like, they go three hundred and fifty Dollars into student loans and they say, “I don't want any more debt”, and now they go get a job at Aspen and then they go buy a house and a car and they start eating out dinners and living, kind of, a nice life and it's like, “Okay, so, now you're going to work at Aspen for twenty years to pay off your student loans.”

Chad: Yeah.

Howard: So, it's kind of like ... so, the question I have is, you bought a big office. That's rare for a kid five years out of school ...

Chad: Yeah, yeah.

Howard: ... to buy a nine-operatory, thirty-three hundred square foot practice. What were your thoughts there?

Chad: Well, I was in a bigger practice, you know, in Ohio and that kind of trained me, you know, how to own and manage that kind of practice and handle that kind of workflow. Obviously, a new grad can't do that. I mean maybe there's a few out there but by and large I don't think a new grad can do that and that's why, you know, I'll be on Dentaltown and I'll hear people talking about the whole debt thing, like, I'm already four hundred thousand Dollars in student loans, I don't want to pick up another, you know, one point four or five million Dollars in practice debt. But I think you need to ... a lot of people need to realize that a practice debt really isn't ... it's a debt, yes, but it's almost kind of a needed debt to get your cashflow to get you where you want to go. Obviously, you have to do your cashflow analysis on these practices to make sure that makes sense, but my ... the other advice I have for people is that you've got to be an associate, you've got to learn this stuff. You know, like, if you go out and buy this five hundred thousand Dollar collection practice, that's not enough cashflow to pay off your student loans, especially from what I see people are coming out now with. That's why you do your time, do your DSO, your large private practice, whatever, get your experience in, make a little money, pay down the student loans and then actually get a bank to loan you. You know, you show you can produce, the bank could even loan you that money, as opposed to coming right out of school - it's not going to happen, you know, you'll just never get there. And, so, you see people end up just being ... they get used to that lifestyle of working for Aspen - making a lot of money, but they just have to crank that out for twenty years, like you say.

Howard: Did you have problems getting financing for ...

Chad: No.

Howard: ... a practice that big?

Chad: No. I actually had banks competing at that point.

Howard: Who were competing? Which banks?

Chad: I had Bank of America and it was ... the other one that was competing was ... it was a smart bank here in Phoenix. It was First something? I forget the name now because it's been so long, but, yeah, they were going back and forth fighting with rates, you know.

Howard: And then what kind of rates and how long was the loan? Was it ...?

Chad: I got a ten-year loan at four point two nine. That's what I ended up with and this was ...

Howard: Ten-year at four point two nine?

Chad: Yeah, yeah.

Howard: And, you know, it's so relative. When I got to school in '87, the mortgage ... the going rate for a mortgage on a house was fourteen percent.

Chad: Wow! Student loans were that high too, right?

Howard: And, so, [...]. Oh, it was crazy. I mean, when ... so I got out of high school in 1980 and that was when the New York Fed chairman - oh, what was his name? Oh, Paul Volcker! How ... Paul Adolph Volcker born, he was an American economist, he was Chairman of the Federal Reserve under Presidents Jimmy Carter and Ronald Reagan, from August '79 to '87. He's widely credited with ending the high levels of inflation seen in the United States during the '70s, '80s. It was an amazing story. He was appointed by Jimmy Carter - and Jimmy Carter didn't get any credit for this - but Jimmy Carter was a very smart man. He said, “Why is the economy so boom-and-bust, boom-and-bust, boom-and-bust?” And they said, “Well, the presidents want a robust economy going into their four-year election. So, they make money real cheap and they throw out a lot of cheap money to fuel up for the election. Then after the election, they clamp back down.” And Carter said, “Well, that's insane.” And Paul Volcker said, “You need to stamp out this inflation.” And so, Jimmy Carter appointed him. All of his Democrats voted against him, because they knew what was going to happen.

Chad: Yeah.

Howard: And all Republicans were like, “Oh, my g*d, this stupid Democrat President Jimmy Carter is going to swallow a poison pill. He's going to take one for the team, be best for the country.” But nobody, especially not the Republicans, they wouldn't touch it. Paul Volcker went in there and, to stop inflation, he raised the interest rates to twenty one percent, and he killed it to this day. But, I mean, it was 1980. So, I had close friends who, you know, their dads were farmers and they had these big loans and the interest rates were floating and they went in the barn and blew their head off because they were going to lose ...

Chad: I can imagine.

Howard: ... the fifth-generation family farm. And how would you like to be the great-great-grandson of a wheat farmer in Kansas and you lose it. And Paul Volcker was escorted from his house to the Fed every day in armed security. So many people wanted that guy killed.

Chad: Wow.

Howard: But to this day we really don't know what inflation is.

Chad: Yeah.

Howard: And, so, all the ... but, anyway ...

Chad: But, yeah, I'm happy, I mean, with four point two nine.

Howard: Yeah, so, four point two percent! Well, back to debt, I think people use the term wrong. I mean, like these people come out of school and they'll say, “Well, I have three hundred thousand Dollars of student loans”, and they'll throw a pity party like they're some victim ...

Chad: Yeah.

Howard: ... and it's like, and the next thing you hear them, you know, they're working at Aspen, then the next thing you hear from them, you say, “Well, what are you doing?” “Oh, we just bought a house in Chandler!” “Well, how much was your house? Three hundred fifty, huh? So, three hundred thousand Dollars of student loans you thought, everyone was a pity party. And why did you buy a three hundred and fifty thousand Dollar house while you're an employee? Shouldn't that three hundred and fifty have gone to ...”

Chad: Student loan.

Howard: “... a student loan or a big dental office?”

Chad: Yeah, yeah.

Howard: You know, or dental office? So, and, yes, so you'll see them. They ... three hundred and fifty thousand Dollars of student loans, within two or three years they buy a three hundred and fifty thousand Dollar house, they're driving to sixty thousand Dollar sports car, and then they want me to feel sorry for them ...

Chad: Yeah, yeah.

Howard: ... because of their student loan debt. So, debt for going to dental school and becoming a doctor or buying a dental office business, that is leverage.

Chad: I look at it that way.

Howard: Debt for a house, a car, a jet ski and a cruise - that's just raw, naked consumption.

Chad: Yeah, yeah. I a hundred percent agree. I mean, I look at all debt differently. You know, a car loan is a lot different than a student loan, it's a lot different than a, you know, practice loan. You know, there are some that are generating income and some that are just costing you, you know. And I think that's ... I see even on, you know, Dentaltown, there's a mindset out there that some people are just debt is debt, you know, and I think that the sooner you can feel that practice debt is, you know, it's overwhelming but you got to just look at the cashflow standpoint.

Howard: Yeah, well, it is purely leverage. I mean, you could have gotten a job at McDonald's in Iowa for ten years at ten Dollars an hour, and saved up and gone to dental school but you said, “I'm going to use leverage, I'm going to use other people's money and I'm going to come out of school a hundred thousand Dollars in debt but then I'm going to pay it back, not making ten Dollars an hour but making a hundred Dollars an hour.”

Chad: That's right.

Howard: So, it was a 10x leverage to say, I want other people's money. Same thing with that dental office. If you come out of school and you open a scratch dental office, it might take years to build it up and get it going.

Chad: Yeah, yeah.

Howard: And you don't know, I mean, you can ... you still have risk. I mean, you might not build it up and get it really going. Maybe there's too many dentists in the area. Maybe a 2008 will hit and contraction.

Chad: Yeah.

Howard: But when you go buy an existing practice, how ... this practice you bought, how old of a practice was it?

Chad: Well, it was two practices that merged in 2011. The guy that owned that building and probably the bigger of the two practices, he had passed away fairly suddenly.

Howard: How old was he?

Chad: I think he was around forty or fifty.

Howard: Damn, that's young! What did he pass away with?

Chad: Cancer.

Howard: Which kind?

Chad: I think it was ... I'm going to say pancreatic cancer. I can't recall exactly. I never knew, or never met him, but I hear great things about him just about every day. It was the two practices combined, and so it was a bigger practice. Then over the last few years, the guy I bought it from, you know, just got a little more lax and sort of ran out of energy for it. So, that's why I came in. It was a great opportunity, you know, just to pick it up and, you know, take it from there.

Howard: So, first of all, let's talk about that. So, in Wall Street, M&A, mergers and acquisitions, is huge.

Chad: Yeah.

Howard: And if you track merger and acquisition activity, it's very predictive and correlative of where the economy's going. And dentists, I mean, you see it all the time, there'll be a small town, there will be six practices, some old guy puts his practice up for sale. Wall Street would say, “Oh, my g*d, I'm going to buy that, and roll that into my office because there are six offices. I could buy that and roll it into mine.” Now we've gone from six to five, and then you take the purchase price of that practice, divide it by the number of active patients, and you're usually buying patients cheaper than you could buy them through advertising.

Chad: Yeah.

Howard: And advertising, you're going to pay at least one hundred and fifty Dollars per head, and they don't know you. But when the guy selling the practice says, “You know, what I'm going to retire, and I think the best guy to see my patients is Chad Hines.” Now they come in with all this stuff like that, and then the dentists don't do that and then some young guy like you, I mean, you don't ... you have no idea how much more energy you have than me. You're twenty years younger, I mean.

Chad: Yeah.

Howard: And, so, now they're in this small town and some young thirty-five year old, full piss and vinegar Chad Hines, who's ready to see a thousand patients and work through lunch and even ... and now you've got to compete against that. And it's like where, why ...? So, that was interesting, they got to a nine office by merging ... a nine operatory, by merging two practices together.

Chad: Yeah.

Howard: So, now, are you doing all of those patients yourself or do you have an associate?

Chad: I have. When I came on board it was the current owner and another associate. And he had left within a few months, and so it was me and his old associate, and then I just added a third ... well, second associate, third doctor, to the practice, just because the work for me was just getting too much.

Howard: And what are your hours?

Chad: We're seven to five, Monday through Thursday, and then seven to noon on Friday, and then I come in on weekends as needed, but it's not too often.

Howard: Yeah. And how many hygienists?

Chad: We have four full time hygienists.

Howard: So, and nine operatories?

Chad: Mm-hm.

Howard: Operatories 1, 2, 3 and 4 are always hygiene?

Chad: Yeah. Well, then, yeah, 1, 2, 3 are hygiene and then 8 is hygiene, yeah.

Howard: But four out of nine chairs ...

Chad: Four out of nine chairs are hygiene, yeah.

Howard: ... are doing hygiene?

Chad: Yeah.

Howard: Wow.

Chad: And the rest are the doctor chairs.

Howard: So, now, what is your mix of dentistry? What type of dentistry do you like to do?

Chad: I like ... personally, I like the surgical aspect of it. Yeah, I love placing implants, love extractions, you know, kind of the bloody stuff. It is kind of my favorite. I like, you know, I like more complex cases, you know, it keeps life interesting. Worn dentition, those are always fun. Implants. I would say, you know, my favorite part of day would be, you know, placing implants, extracting teeth. And then either two associates, they don't do a whole lot of that, and, so, but, you know, it's ... part of the problem is, I came into the practice and, you know, you put your game face on for the first year and a half because, you know, that's your baby and you've got to milk that, you know, you've got to treat these patients well just to retain them. But, now the problem is they all want to see me for everything. And so, now I'm trying to just get, sort of, focused on more implant, surgical stuff, and then some of the other associates are taking care of the other stuff.

Howard: So, when they come out of school it looks like, you know, an endo we, you know, if you're like me where you want patency at the bottom of the apex.

Chad: Yeah.

Howard: And when you operate that thing you want to puff a sealer at the ... and you're an ape-ical  barbarian. And if you read too many endodontic textbooks and you want to be a half millimeter short of the apex and all that, and make it all clean and pretty, you're a pulp lover.

Chad: Yeah.

Howard: But I take that on more than dentistry. Some many of these kids come out of dental school and they don't like blood, and they just like the white, pretty stuff. They want to do bleaching, bonding ...

Chad: Yeah, cosmetics.

Howard: ... veneers, cosmetics, sleep apnea, Invisalign. And then there's these bloody barbarians like you and me who just, I mean, like, one of the reasons I pull wisdom teeth so fast, I mean, I can pull all four wisdom teeth in under ten minutes ninety nine percent of the time that there's nothing that tooth can do to hang on to that jaw. But when I lay a flap, I mean, I peel it like a banana, I see white mandible. When I erase buccal bone, it's like one time, it's like gone, boom. But to me it seems like the people that like blood and guts, whether it be extractions, root canals, implants, it just seems like it's an easier path to success, than if you just don't like blood and guts.

Chad: Well, I think, you know, especially ...

Howard: And one last thing, but the average general dentist makes one seventy-four take home, but endodontists are three fifty-four, oral surgeons are four eleven. I mean, if you just look at the nine specialties, the endodontists and the oral surgeons and the periodontists are making two and a half times a general dentist. So, the white, pretty stuff doesn't really show up in the numbers.

Chad: You know, a hundred percent. The biggest thing I see too is that there's a lot of big cases that hinge on implants, endos, extractions. You know, if you say to a patient, “Well, I’m going to refer you to this guy for this, this guy for this, this guy for this.” They kind of go, “Oh, okay.” And they just, kind of, never. Or you just say, “We're going to do all this. This is how we're going to sequence it. We're going to do it like this.” They say, “Where do I sign up”, you know, and that's ... especially in probably the last eight to ten months, I don't know if it's an economy thing or just, you know, I'm getting more comfortable, you know, doing this stuff, just left and right, you know, these big cases where they need two implants, you know, three root canals, a bunch of crowns, opening the bite, the whole works, you know. So, I think even just from the fact of doing the procedure, you know, and the profitability from the procedure, it's just the whole case in general, case acceptance.

Howard: Yeah, and I ... now, are you born after 1980? Are you a Millennial?

Chad: I was born in '81.

Howard: So, you're a Millennial then, so ...?

Chad: I guess so.

Howard: Yeah, 1980 is the beginning of the Millennials. '45 to '64 is a Baby Boomer - I was born in '62, so I'm a Baby Boomer. But it seems like the Millennials are the first generation in the history of humanity where they're obsessers. Well, do I like my job? Does it have meaning and purpose? I mean, for the last two million years a hundred billion sapiens have come and gone. How many of the hundred billion sapiens have said, “You know, I like eating Mastodon shit in a cave. I like finding ... coming across a rotting, four-day old animal and chewing the cart.” I mean, there's a shit load of humans in the last two million years that didn't love their job and they'll say things, “Well, I don't really like endo.” Well, I don't give a shit if you like endo. You have three hundred and fifty thousand Dollars of student loans. This person's in pain. They didn't go to sleep last night. You're a doctor. They took time off work. They show up in your office and you're like, “Well, I don't like endo.” Well, maybe you won't like the first hundred, but you'll like the second hundred more and by the time you do your third hundred, you're just sitting there saying, you know, you like what you're good at and how can you get good at it if you never do it because you say you don't like it and maybe you should just do your damn job and learn to like it.

Chad: Yeah. Yeah.

Howard: You know what I mean?

Chad: Yeah, I mean, obviously, you know, there's a competence level there that, but, yeah, I mean.

Howard: But how do you get competent if ...

Chad: Yeah, if you don't do it.

Howard: They'll say like, “Well, I refer out second molar.” “Why?” “Well, I'm not good at second molar.” “Well, how many second molars have you done?” “Well, I don't do them because I'm not good at them.” Well, maybe you should do the next hundred.

Chad: Yeah.

Howard: And I'm sure after the next hundred, you'll be twice as good at second molars. And the thing I don't like about ... can you imagine breaking your leg and going to the hospital and the doctor says, “Well, you know what? We don't do legs. Yeah, we just do arms and fingers and ears, but you need ... here's a referral and I know you came in an ambulance and you're in pain but, you know, go make an appointment across town.” I mean.

Chad: Yeah.

Howard: You know, there's nine specialties. One of them is public health dentist, and, you know, everybody wants to talk about ortho, periodontist, pediatric dentist, but you're a public health dentist. When someone shows up in your office and they're in pain and you have a dental degree, maybe you should fix it.

Chad: Yeah, absolutely. And not only that, it's from even, you know, learning it from a diagnosis standpoint, you know. I mean if you're great at, you know, endodontics, you're pretty good diagnosing it too, and I even think that goes into implants as well to where, you know, how do you diagnose and send to a periodontist or oral surgeon for an implant if you don't know if that needs grafting, you don't know what's it all involve and you don't even know how to restore it, you know, when it comes back with the implant. So, I mean, you got to learn, you got to learn this stuff, you know.

Howard: And that's what I've always told the orthodontists. Every general dentist who ever went and learned how to do their own ortho, usually within two years they stop doing it, because the orthodontist is flipping these patients every fifteen minutes.

Chad: Yeah.

Howard: And all [...] and all that stuff. But after they quit doing it, they diagnose two to three times as much ortho.

Chad: Oh, yeah.

Howard: Because they didn't see it before they learned how to do it. Now they see it. So, when you came out of school, how many implants have placed at Iowa?

Chad: We didn't place any in our program.

Howard: So, how do you go from, I graduated dental school in 2010, I've never placed an implant, and now you're doing these implant cases with a CBCT?

Chad: Yeah, well, obviously, CE. You know, a lot, a boat load of CE. You know, I basically for ... it was about a year there I just tackled every CE I possibly could, you know, that sounded interesting and that'd get you a good experience. And then, as you take one, you just, you advance to the next level and to the next level and, you know, the last one I took recently was at the Brighter Way Clinic here in downtown, where you did a lot of edentulous implants.

Howard: Was that with ... who was that?

Chad: Joe, Dr. Joe Mehranfar.

Howard: Right.

Chad: Yeah, yeah.

Howard: And he teaches at the ...

Chad: He does a lot of things.

Howard: ... at Midwestern.

Chad: Yeah, he's a little everywhere doing stuff.

Howard: Is he a friend of yours?

Chad: No, I just know from the course.

Howard: Yeah. I need to get him.

Chad: I got ...

Howard: Well, who were your standouts in your implant training? Dr. Mehranfar?

Chad: I took a course with Leo Malin up in Las Vegas. He's based out of Wisconsin.

Howard: What was his name?

Chad: Malin, Leo. M-A-L-I-N.

Howard: M ... Leo, L-E-O, then?

Chad: M-A-L-I-N.

Howard: Leo Malin. And is he an orthodontist or an oral surgeon?

Chad: He's a general dentist.

Howard: And he teaches implant surgery?

Chad: Yeah, yeah.

Howard: In where?

Chad: I think, well, he's based out of Wisconsin, but the course I took was at the LVI. That's the only course I've taken at the LVI, was their implant course.

Howard: Huh, Leo Malin.

Chad: And, you know, a lot of the stuff is Dentaltown, you know, learn a lot on Dentaltown, and then just obviously research and, you know, you get in a little ... few, little, small complications, you start with ...

Howard: When did you start Dentaltown? Was that in dental school or after you graduated?

Chad: You know, I think I browsed it a ton before I created a login and started get active with it. The more I wanted to learn, like, that's when I started to become active, and more converse with people and ask questions and throw things out there and respond to things.

Howard: You know, what is it about the posters? I mean, most of my emails are asking me questions and I say, “Well, you know, you should ask this on Dentaltown.”

Chad: Yeah, yeah.

Howard: And they're always the same thing, they're scared, they're shy ...

Chad: They're behind a keyboard!

Howard: I mean, there's people that have been on Dentaltown since 1998 to 2017, they come on three times a week for an hour and they've never made a post. And I'll say, “Well, why don't you ask that question on Dentaltown?” And they're just scared. Why? Why do you ... I mean, you've made four hundred posts.

Chad: Yeah.

Howard: Why are you not afraid to ask a question? And ninety percent of your comments are.

Chad: I guess it all starts with, you know, the first post. If it goes successful, you keep posting, but you'll see a lot of, you know, obviously with any message board of any type or whatever forum, you'll see people with negative reactions, saying, “Oh, you're doing it all wrong!” You know, I think that's what people fear, if I had to guess. You know, you just ... people throwing each other under the bus and that happens, I think, in any forum. But, you know, by and large, you know, ninety five percent it's all positive stuff, they're there to help you. You know, I'm there to help people, you know, give them my feedback or I'll throw things out there, hoping the same.

Howard: Yeah, and, you know, even lecturers. So many of the lecturers, you know, they're used to ... they just lecture and give a presentation and they are literally shocked if someone disagrees with them. And where I come from, the camp of ... there's seven and a half billion humans on earth and ...

Chad: Oh, yeah, yeah, absolutely.

Howard: ... you can't get two of them to agree on anything.

Chad: Yeah.

Howard: I mean, even my two sisters that are nuns - Catholic nuns - disagree on half the issues in the Bible. Look at the Supreme Court. They're all reading the same constitution, they all went to law school and most of all the major decisions are five to four.

Chad: Yeah, interpret this differently.

Howard: So, it's like ... so, dentists, I mean, if you think you're going to get all the dentists to agree with you ...

Chad: Yeah.

Howard: ... you need to just start drinking heavily right now.

Chad: Yeah, yeah, absolutely.

Howard: 'Cause it's never going to happen!

Chad: I mean, dentistry, it's, you know, it's not black and white, that's for sure, you know, there's ... the majority of it's a gray area, in other words, you can, you know, do it eight different ways and probably get the same result, you know. It's just how someone might have a different experience doing one thing and the other guy has a different experience doing another, and usually, I think, we all end up with the same result, hopefully.

Howard: So, you ... so, what ... so, you said you went to the Straumann system.

Chad: Yeah, it was all Straumann.

Howard: All Straumann. So, Straumann is out of Switzerland, Novel Biocare is out of Sweden. What made you pick Straumann out of Switzerland?

Chad: You know, I was going ... you know, there's a lot of systems out there and I guess some of my experience restoring implants is that the parts and pieces are, you know, there's ... I'm sure you have, you open a drawer and there are just pieces everywhere, you know, and well, I wanted to focus in into one system, you know, place one system, restore one system, just to keep your inventory down and be good at one system. You know, every restore's different, you know, Nobel, whatever, and it's just a little different. You know, sometimes I'm like, okay, I'm not real familiar with this, but I like Straumann because it's probably not going to change and it's always going to be there. You know, my fear is, which I think is going to be an issue in dentistry in 2010 now, even in years, that we've got so many implants out there and there's so many small companies that when these guys go under, where's the parts, you know.

Howard: And how many have already gone under?

Chad: Yeah, yeah. And, so, like, when a guy comes in on Friday ... like, I had this guy came in on Friday at eleven thirty and we close at noon and he's got a loose implant on some system I've never heard of and I can't even find them on the Internet, you know. And, so, I know that Straumann is going to be around. I won't ... because if I'm going to practice for fifteen, thirty years, whatever it may be, their parts are going to be available, you know.

Howard: And here is the other thing. You know, it's one thing when you mess up on a single tooth, let's say it's a failed root canal. One of the reasons you're ... you can tell how much lawsuits are going on by your premium.

Chad: Yeah.

Howard: Like dentists say, “Well, there's so much lawsuits going on.” Then why is your premium so low?

Chad: Yeah.

Howard: I mean, an OB-GYN, their malpractice is over a hundred thousand Dollars a year, because when you screw up a baby ...

Chad: Yeah, it's not a tooth.

Howard: ... you know, when you screw up a newborn baby, you're in deep shit trouble ...

Chad: Yeah, yeah.

Howard: ... and the whole family wants to kill you. But with these implant cases, these are the bigger cases, and, my gosh, when a big implant case goes south and then you go to court and, you know, if Nobel Biocare or Straumann or Implants Direct or any of these major companies, they have tons of research that shows everything they did. And you're using some no name brand, some eighty-nine Dollar implant from Russia …

Chad: Exactly.

Howard: ... and it's not pretty.

Chad: Yeah, yeah. I mean, it's ... I mean, Straumann, obviously they got ... I think they're the number one selling brand too. Obviously, they have all the research behind them.

Howard: Well, they went on a big M&A activity. They bought the number one implant system out of Brazil, Neodent, they bought one of the biggest ones out of Israel, they almost bought Megagen out of South Korea but that fell through at the very end - which makes me think, you know, they might go back to that drawing board. So, lots of M&A, so, they're a major player.

Chad: Oh, yeah, absolutely. You know, with some of them, I don't know what their goal is, with some of these - if they're going to just keep selling them or just eliminate some of the market of other implants, but, you know, I think ...

Howard: You mean, like, them buying Neodent?

Chad: Yeah, yeah.

Howard: Are you using ... now, since you use Straumann, do you only use the Switzerland Straumann?

Chad: Yeah, I only use the ...

Howard: Or do you use some of their other portfolio stuff like Neodent?

Chad: No, just, I mean, the Switzerland Straumann straight up. I mean, I get the reps come in quite a bit, you know, with their stuff but I don't know, I've just had so much success with Straumann that it's hard to, you know, I don't have a lot of reason, other than they're a little more pricey.

Howard: And what's your favorite implant out of Straumann? Which one do you use the most?

Chad: I use, really, the bone level. The BLT, or the bone level ...

Howard: The BLT?

Chad: Yeah, yeah.

Howard: The bacon, lettuce and tomato?

Chad: Yeah, they have this new one, that's what it's called. No, it's the bone level tapered. But, just the cross fit, the rock solid, yeah.

Howard: Bone level, the BLT, the bone level tapered?

Chad: That's the tapered one, which is going to be your non-guided, and then they have a guided that's just called the bone level, or the BL, that you use for guided surgery. It's going to be a parallel ...

Howard: Okay, well, you just walked into the biggest ... you just walked into the sliding glass door on Dentaltown implants. One of the most controversial things on implants in dentistry is the guided surgery. So, you have all the old Baby Boomers. You find any fifty to seventy year old oral surgeon, periodontist, dentist, that's placed a thousand, five thousand, ten thousand, they never use a surgical guide.

Chad: Yeah.

Howard: Then you meet any Millennial who's placed under a hundred and they swear you have to have a guided surgery.

Chad: I started that way.

Howard: You started with guided surgery?

Chad: Oh, absolutely, I didn't feel comfortable quite, you know, just to ... and after you do enough guided, and then you start opening tissue more and you get more comfortable and now I do less guided than I do guided. I'll do guided for, like, multiple unit cases.

Howard: Yeah, guided for multiple unit. I can see that would be ...

Chad: Yes, it's just for placement, I mean, because on the CBCT you can just ... you can virtually put the restoration there so you're going, you know, just right in the middle of each restoration because it's a restorative, you know, procedure, it's not a surgical procedure so, I put it right underneath where my planned restoration is not where necessarily I just think that ...

Howard: Every laboratory technician that I know that's done it for thirty years and has made ten thousand restorations or more, or twenty or thirty thousand restorations, they say in every one of their clients, they can tell if you're right handed or left handed.

Chad: Oh, yeah, 'cause it tapers.

Howard: Because they're all tapered towards the right hand, and it makes you want to keep ... every time we tell [...] I want to move the patient into twelve o'clock one last time, look at his taper, because it's like, “Okay, how can you make your lab man not know?”

Chad: Yeah, yeah.

Howard: So, but, your first one hundred implants, what percent of those were single units?

Chad: I think probably all of them.

Howard: And what percent of your first hundred were guided?

Chad: Probably eighty.

Howard: Now what percentage of them, on a single unit, are guided?

Chad: Twenty to thirty percent, I would say, just, even if it's a, you know, if there's narrow bone and the patient's got, you know, some medical history, you know, question marks and I refer that.

Howard: If you ... say that again.

Chad: If they have, you know, if it's a real skinny, you know, ridge story, you know, you're basically ... you're going right between two cortical plates, you know, I'll refer that out because that's probably a grafting case, or if the patient has some significant medical history.

Howard: And who are you referring to in the Valley?

Chad: Dr. Augustine. Dr. Kimble for periodontist.

Howard: So, Kimble for your periodontist.

Chad: Yeah, he's over in Arrowhead area, and Dr. Augustine, he's at, like, fortieth ...

Howard: Oral surgeon?

Chad: He's a periodontist.

Howard: So, you're using periodontists mainly?

Chad: Yeah, honestly, I, you know, I'll get ...

Howard: So, let's talk about that. So, a lot of people, the oral surgeons are, you know, they're just big flaps looking for the right bone and placing great bone but less concern of the tissue and the jaw.

Chad: Yeah.

Howard: Is that a bad rap for them or do you ...?

Chad: You know ...

Howard: You refer to two guys and they're both periodontists.

Chad: Yeah.

Howard: Do you think the periodontists are doing a better job than the oral surgeons?

Chad: You know, I don't have, you know, a good enough sample size probably for that but I would say that they're a little more gentle with the patients and I tend to find that their angulation is a little bit better. I mean, I don't refer too much for oral surgeons for implants, however, I get a lot of them to restore, you know, either just from the patient knows an oral surgeon, they go there, whatever, and I find that the angulations, you know, and the placements a little more accurate with the periodontists, and that's just, you know, like I said, I have a small sample size.

Howard: And that's why the one oral surgeon who's placed one of the highest levels, Jay Reznick, who's an oral surgeon in L.A., who's made several courses on Dentaltown. He's the only oral surgeon I know that uses guided surgery one hundred percent of the time. And Jay tells me and texts me, you know, every ... all ... at least every week that, “Howard, if I freehand it and I get it right ninety nine percent of the time, that means one out of every hundred ain't perfect and my referral's looking at something that ain't perfect.” And Jay says, “I'm going to nail it every single time.”

Chad: Yeah, it takes that one time.

Howard: And he's an oral surgeon, and I think they have to fight that bias that oral surgeons are a little rough, not into the angulation, and he's an obsessed oral surgeon with guided surgery, and he admits it's probably only affecting one or two percent of his cases. But he said he ... well, you know, another great example is the airline industry. If they had a ninety-nine point nine nine success rate ...

Chad: A lot of people would die.

Howard: That means four airlines ... four airplanes would crash every day in America.

Chad: Yeah.

Howard: So, ninety-nine point nine nine ain't good enough for a pilot. They need nine nine nine nine. They need six nines after that point.

Chad: Yeah, yeah. And, you know, the only time, you know, if I have any question whether we're close to anatomy or, you know, we're close to perforations or, you know, we got some weird angulations of adjacent roots, it's definitely guided, but, you know, if you've got a big fat bone and, you know, hitting right in the middle, that's going to be pretty straightforward, usually I go non-guided, but.

Howard: So, Carl Misch did, I think, the most famous podcasts I'd done so far. He did it basically on his deathbed. And it was a very interesting, you know, I do my shows - they're an hour 'cause the commutes an hour - but we were at two and a half hours because he was dying and he felt he had a lot of stuff to say, and I'll tell you what, man, you're a different beast on your deathbed because you know you're going down, and he wanted ... and he had so much to say, I just let him carry on ranting and ranting and ranting, but he ... one of the most controversial things he said was that drawing blood and splitting platelets and ... it's all bullshit, it's all voodoo, you don't need any of that stuff and some of my very good friends said, “You know, I just don't agree.” But it's kind of hard not to agree with Carl Misch.

Chad: Yeah, yeah.

Howard: I mean, he wrote the number one selling text book of all time in any subject: Misch Implantology, and some people say, “Well, Carl Misch spread a lot of ‘misch’-information”, but that guy ...

Chad: I've heard that.

Howard: ... that guy was one of the biggest gurus, probably it was Brandmark and then Misch.

Chad: Yeah.

Howard: I mean, really, kind of like it was Pierre Fauchard, then G.V. Black. So, what do you think of the ... one of the greatest implantologists of all time, Carl Misch, saying drawing blood, splitting platelets, all this stuff, just noise.

Chad: I don't do any of the PRF stuff. I mean, there's just so many ... and that's the thing too, it goes back to your talk about Dentaltown and different people have different opinions on and that kind of stuff. I suppose it doesn't hurt. You know, I say it hurts to get, you know, the prick, the blood, take the blood, but, you know, you see all these cases come out great, you know, that didn't have all the fancy stuff, and then you see some of these cases that had the fancy stuff fail. You know, I guess, to me the jury is out on a lot of that stuff. To be honest with you, I don't know if I have a strong opinion either/or on, you know, all the fancy ... the grafting ... you know, there's always grafting.

Howard: I would say that dentistry is an art and a science, it's definitely more art than science only because we're at a time of the information curve for homo sapien that I don't even think sapiens at this point in the journey know ten percent of all we're going to know about dentistry a thousand years from now. I mean, when they write the last textbook on dentistry and there's no more future editions, you know, I think what is 'Pathways of the Pulp' on what, the eighth edition or ninth edition? But when there's no more editions in dentistry, I don't think we're ten percent of the way down that journey. And, so, but, and some of my friends, one of the things they like about this spinning the blood and all that is just when they're mixing that with their bone grafting, the putty, you know, it's just the art of it all works better in their hands.

Chad: Yeah, yeah, and I think, you know, it can be from a membrane standpoint, it's their own membrane which is great, you know, it saves your bio-materials, you know, that you're using. But, yeah, I mean, with this information stuff, you'll hear this, you know, this certain aspect or this way to do it is gospel, and then four years later there's a new one, there's a new way.

Howard: Yeah, even that saying, I love it when people say, you know, it's gospel. You know, the Bible has Matthew, Mark, Luke and John but they've actually identified nineteen gospels and there's a lot of disagreements among nineteen gospels.

Chad: Yeah, yeah.

Howard: So, when anyone says, “This is gospel”, it's like, dude, there are nineteen gospels and they disagree on all this stuff. So, you bought a CBCT. Which one did you go for?

Chad: I have the OP300, the Maxio. So, it gives the full field of view.

Howard: OP300?

Chad: 300 and that's a KaVo or Instrumentarium brand, same thing. I bought that ...

Howard: Insta ...?

Chad: Instrumentarium.

Howard: Insta ... that's a hard one, I've always said. Insta ...

Chad: Instrumentarium, I guess you would say.

Howard: Instrumentarium.

Chad: Yeah, it's a KaVo brand.

Howard: Yeah.

Chad: I think I, yeah, you can see there's a picture on my website up there of it. I love that machine. I practice dentistry different since I use that. I mean, even from ...

Howard: How much did you pay for that?

Chad: I paid a hundred and five.

Howard: And was it worth a hundred and five?

Chad: Absolutely.

Howard: No buyer's remorse, no buyer's regret?

Chad: No, I mean, not a cent of it. I use ... I mean, I just ... a) it takes pantomographs, it takes extraoral bitewings as well. So, I mean, at some point, if you're going to replace your pantomograph machine, you know, that's included, kind of, inside of the cone beam. But, no, I mean, even from ... I mean, I ... there have been a lot of cases where I'll go and put an implant in and you'll see, you know, this mile high ridge that's so sharp that if you didn't have a cone beam, you know you're going to be in trouble. And so, those kind of cases, it definitely saves your butt. Or else you see cases where, you know, you've got a patient complaining of pain and, you know, you just don't see anything on a P.A., and you know there's something wrong. And so, you take a cone beam and, you know, there it is, you know. I do a lot of these services at no charge to the patients. You know, the patients love it and not only that, I mean, it feeds into you're going to do more implants, you can do more endo, you're going to do more you name it, and you're not going to put the patient through a big run around and going to endodontists and periodontists to figure things out, you know. You can just take this quick scan, you'll figure it out.

Howard: I just re-tweeted your Twitter 'Dental Care, Moon Valley. We added a new blog article: What if you could vaccinate against gum disease?' That is a ...

Chad: We use Great Dental Websites, and I think they have some of that going for us. They do our website and some of our Twitter stuff as well.

Howard: Yeah, so, a lot of these kids coming out of school here, I mean, we're in Phoenix and we've got A.T. Still in the suburb of Mesa, Arizona. We've got Glendale to the west.

Chad: Midwestern.

Howard: They're graduating a hundred and forty students a year. These are both private schools and they're paying a chunk of change to go to these two private schools. They're coming out like three hundred and fifty thousand Dollars in debt. And a lot of them, they come out and the first thing they think is, Should I go invest another hundred and fifty thousand Dollars in a chairside milling CEREC machine. What are your thoughts on chairside milling and CEREC in general?

Chad: You know, when I was in Ohio, I did hundreds, if not thousands ...

Howard: Hundreds, if not thousands of CERECs?

Chad: Yeah, I mean, that was ...

Howard: For five years in Ohio.

Chad: That was three, four, five a day, you know.

Howard: Three or four or five a day?

Chad: Yeah, we were cranking them out.

Howard: Holy, moly!

Chad: Yeah, we had a lot of ... big patient base there, you know, and I did it from the Bluecam, then to the Omnicam the last year or two. You know, I think you can get some great results with CEREC. I think case selection is critical. You know, I'll see too many busted E-Max's on, you know, grinder's, you know, second molar CEREC restorations. So, case selection is important, but I have a Bluecam that I very rarely use, except for in certain situations where the patient just needs a crown today, just because ... I mean, my machine probably needs to be updated to the Omnicam, but I just can't justify it, even with a busy practice. Like last year we did like seven hundred units of fixed, you know, and I still couldn't justify it because I mean you ... I can get some really great, you know, zirconia or even E-Max crowns for eighty to a hundred bucks from a lab. You know, I can go into a room and, you know, numb and prep, you know, in, you know, eight to ten minutes, and take an impression and the system makes a temp, come back and, you know, if you get a good lab, your seating time is ten to fifteen minutes and that frees up the rest of my time, you know. And, so, I just feel that ...

Howard: Whereas, if you were going to do it ... so, if I came into your office, busted molar, you're going to numb, prep, impress, temporize and send me out the door, how long would you schedule me for in that room?

Chad: We just do ... we do a lot of just straight hours.

Howard: Okay, one hour.

Chad: Yeah.

Howard: Okay, but if you were going to chairside mill it, how much time would you have to schedule in the chair.

Chad: You know, I usually ... I would probably go an hour and forty, and I know a lot of ... you know, I've been to all the CEREC courses and all that, and they say, “Oh, you can do it in an hour, you can do it in an hour.” I did a lot of them and I couldn't. I mean, it's just out pushing it ...

Howard: But, yeah, absolutely, absolutely. What do you think the average person on Dentaltown, how long it takes them to do a chairside crown, start to finish?

Chad: Well, I mean, if you're doing something you're milling ... I'm sorry, firing ...

Howard: Right.

Chad: ... with E-Max or now zirconia ...

Howard: Right.

Chad: ... I mean, some of that sintering time is twenty minutes, twenty-five minutes, you know, and right there is basically a half hour by the time it cools off, getting it in the oven, the whole works, and then you numb the person, there's another, you know, ten minutes ...

Howard: And then if you've got nine ops and four of them are taken by hygienists, and you've got an associate ...

Chad: Yeah, yeah.

Howard: ... you want that chair.

Chad: Yeah, and I think that, you know, unless you have a really, really ... I think if you're going to make a go out of it, you've got to have a really good assistant that you can trust, that's going to get you a good restoration, because if you're spending all that time by yourself doing it, you know, that's a lot of your time, whereas you could be in hygiene discussing someone else's treatment, as opposed to blowing them off and flying in, flying out, you know, coming back to your CEREC machine, to save yourself ten minutes.

Howard: Yes, some of my heavy hitter friends here, right here up the street from me, that I've practiced across the street from for thirty years, now what they do with their CEREC is they scan them all, they temporize and send them out and then they have a lab person from a local lab come, like, Wednesday after work, one night a week, and do all their crowns.

Chad: Yeah, yeah.

Howard: And, so, even then ...

Chad: That would be effective. I mean, I think that's effective.

Howard: So, what the lab are you using?

Chad: I use a lab, Desert Valley Lab. They're a smaller lab. They focus mainly in zirconia.

Howard: Here in town, Desert Valley.

Chad: Yeah, yeah, they're in Glendale. I use ... it all depends on what I'm doing, but then I use Hershberger for some stuff.

Howard: Here in town?

Chad: Yep. Van Hook.

Howard: Ryan, can you ... Oh, Van Hook?

Chad: Yeah, I use Van Hook for like all-on-fours or certain denture cases. I use John Henry ...

Howard: Van Hook for what? Did you say all-on-fours?

Chad: All-on-fours. I do a lot of all-on-four cases with Dr. Augustine, the periodontist, and we use Van Hook for them. Lot of just basic removable I'll use John Henry & Crane. I think they're out in Mesa. And that's getting ...

Howard: He's gotta be to getting up there.

Chad: Yeah, I talk to him a lot. He does a lot of my cases.

Howard: My kids went to school with Van Hook's kids.

Chad: Okay.

Howard: So, I used to see him ... I used to see him thirty years ago dropping off my boys at school.

Chad: Yeah.

Howard: He was going there, but ...

Chad: And I use ...

Howard: John Henry and Van Hook, they've been doing it ...

Chad: They've been doing it for a while. I tried a lot of different labs but I just kind of seemed to kind of hone into those and I use Arrowhead down in Utah for some cosmetic stuff.

Howard: Did you ever meet Dick Barnes?

Chad: No, I haven't.

Howard: Dick Barnes stood in that kitchen right there. He bought me ... every time he comes over he's always ... he's really into health and fitness, he's like, every time he comes over he's like, “Howard, you gotta take better care of yourself.” But last time he came, he brought a pressure cooker and showed me how to pressure cook whole grain rice. I guess, his formula, he gets up in the morning, he runs his five miles and he comes home and he loads up his pressure cooker with wholegrain rice and that's his main meal. But, I love that guy.

Chad: I've been using ... with the lab thing, I've been ... I mean, I've been here almost two years and so occasionally I'll dabble in some, try them out, you know, throw them some easy cases and see what you get back, you know, so, yeah.

Howard: So, do you ... I notice that most all your labs are local.

Chad: Yeah.

Howard: Yeah.

Chad: I, you know, I sent to Glidewell when I was in Ohio. They're alright. I just ... local are just nice, like, I know the guys that are doing it, you know, and then, bam, they'll send ...

Howard: My only point I want to make crystal clear about labs is this, that, you know, you can believe what you want to believe, but if someone's been doing this thirty years, you've been doing this three, there's some things you really need to think about and lab people are afraid of dentists, and they all, every single one of them, will tell me, you know, they see all this garbage and if they call you they're afraid you're going to say, you know, “Screw you, just send me back the impression, I'll use another lab.” And you think you're humble, but society doesn't. The lab people don't think you're humble. The practice brokers don't think you're humble. You come across to the world as a very arrogant, know-it-all, kind of a dick. And you, if you are that humble person, you need to let your lab know, Hey, I'm not like all the other ones, because like you take Van Hook or John Henry or these local labs, you know, if you call them up and say, Look, I'm a young dentist. I want to be a better dentist. They'll say, Well, you know what, come down here ...

Chad: Absolutely.

Howard: ... and I'm going to walk you through one hundred pans that I received today, and you'll start showing me the impressions and I ... like, you know what I did to my assistant, Jan, for thirty years? When I would take an Impregum impression, I believe all the wet hands should have loupes on. When I go to an office and the dentist has loupes and the assistant doesn't and the hygienist doesn't, I mean, that doesn't even make sense, and then you're saying, “Well, the hygienist didn't find that tartar, or the dental assistant left cement around the temporary.” Well, yeah, well, you're wearing loupes and she's not. Yeah, put them all into it. When I hand that impression, when I say, “Okay, this is good”, and I hand it to Jan, if Jan doesn't agree, she just throws in the trash. I'm not going to sit there and say, “Well, I think it's good.” She says, “Well, I don't think it's good.” And then what happens, we flip a coin?

Chad: Yeah.

Howard: So, Jan throws them in the trash. Jan's the one that's going to be on the phone dealing with Van Hook and I have gone out of my way to tell my lab guys like, “Look, I am short, fat, bald. I'm humble. There's nothing you can tell me that my five sisters didn't call me”, so, you know, you have to get across that and if you have a chance to use a local lab, why are you mailing your impression a thousand miles away in an airplane, when it's really nice if you have a guy up the street because you need that working relationship and then you go down there and you look at these impressions and like half of them still have the bloody cotton roll in there. It's like, “Did you not take …? Why should your lab man be looking at hepatitis, ADC, HPV, herpes?” But, yeah, they could really humble you.

Chad: Well, yeah, it's nice too with the labs, I mean, there will be times where, you know, let's say I end up sending something more to one lab than the other, and I'll get a phone call from the owner saying, “Hey, is our work alright? You know, are we doing something that you know we haven't seen too many cases from you?” “No, no, it's just, you know.” So, there's that communication and they want to know if they're doing a good job, you know, and it's not always just someone different every time making your crowns. And actually, it's kind of funny, you know, with my Desert Valley lab, there was a week there I'm like, gosh, you know, this is just a little different, these contacts are too tight, you know, the occlusions are off. I'll call them up, he goes, “Yeah, we're on vacation for a week.” You know, you can tell the difference from one person to the next, you know, when you're just doing enough of them and you get the same product every time, and you know when it's different. And that's why I love just keeping with these local guys.

Howard: Now, back to Straumann. Do you use a local ... do you have a local Straumann rep?

Chad: Yep. Yeah, yeah.

Howard: And who's your local Straumann rep?

Chad: His name is Mitch Garrison.

Howard: And one thing, and how often do you talk to Mitch Garrison? How often do you see him in the flesh and talk to him?

Chad: He stops by once every three weeks or so. And I mean I do most my ordering online, and so I don't have to call him up for everything, but, you know, if I, if there's a part I can't find online, or I have a question, you know, he's always quick.

Howard: Well, riddle me this. You know, when after half a century of flying around the sun, you know, I've flown around the sun fifty-four times, next August 29th will make fifty-five, you don't really figure out what's right or wrong, but you recognize patterns.

Chad: Yeah.

Howard: You know what I mean, and everyone I know who's got the ... who's placing ... for me the critical mass for a doctor is once a week. Would you let someone give you a vasectomy, who only does it twice a year?

Chad: Yeah, yeah.

Howard: You know, and then he says, “Oops, I accidentally snapped your vas, you know, your nerve. I thought it was the vas deferens, but now you're a eunuch.” But if you're not doing it once a week, I don't think you reach ... I know you don't reach profitability. I know you don't reach quality. I know nobody in the B to C consumer world wants to go to a doctor to do a procedure he can't do. But everybody that's doing one implant a week, they all have a local human rep in the field and then everybody who buys them online has no human relationship on the ground. They never get it going. I mean I even asked T-Bone one time, I said, because Tarun Aguero's very business-minded, costs, and he uses the most expensive Nobel Biocare. I said, Why? He goes, I don't care about any of that. I'm in love with my Nobel Biocare rep, and he or she helps me. So, everybody that reaches critical mass has a human relationship that comes by their office. This guy ... so, what is that person doing every three weeks that you think would be irreplaceable than just buying them on ImplantsDirect.com?

Chad: Well, I mean, any questions, they'll ask about any failures. You know, anything more, and, you know, there's different deals they’ll offer you, different continuing education. They'll come by, “Hey, we've got this new course for this.” You know, “Hey, we've got this deal going on - you buy, you know, twenty implants, I'll throw in this.” You know, and also sometimes I'll order the wrong parts or pieces, and I'm, “Hey, will you just return these for me”, and then he'll get me a credit back. You know, or else if I have ... he's come by to train my staff on the sterilization of the equipment, you know, the burs and the kits, he's trained my assistants on displacement of implants. He's even, you know, “We're going to set up like an implant open house for you. You know, we'll take care of everything, costs and the whole works”, and so, you know, into bouncing ideas off, “Hey, you know, our people are having troubles with this, you know, I have this, what can I do?” You know, they'll find out for you. You know, just having like, you know, someone behind your back that you can just turn to and ask any questions any time, is extremely valuable. So, yeah.

Howard: Let's switch to laser. You bought a Picasso and a Biolase. Are you glad? Buyer's remorse?

Chad: I didn't ... those both came with the practice.

Howard: Okay, so, the Picasso.

Chad: Yeah, I use ... the Biolase, it's so big and hunking thing that I just the Picasso, because most of my stuff is, you know, lasering some extra tissue on a margin or maybe exposing an implant or something like that. But, you know, I haven't really gotten too entrenched into the laser thing. Yeah, maybe, yeah, I could be completely wrong, but I don't see a ton of value other than just cutting some tissue. I know there are some great, fancy lasers out there, but I usually use my Picasso.

Howard: You know another thing, when you bought that practice, you know, a lot of ... I have seen an office near yours that was a disaster because the guy that sold it sold this big office, a big chunk of change. He was into all these full mouth rehabs. And he sold it to a kid that came right out of dental school.

Chad: Yeah.

Howard: This kid didn't have the skill set, couldn't sell it, he couldn't do anything. He took that thing from one point five to about six hundred and fifty out of the gate.

Chad: Wow.

Howard: And you did the opposite work. You found a practice, but you could bring in placing implants and the office currently wasn't placing implants, so you could buy a Dollar bill and bump it to a Dollar and twenty-five cents out of the gate. I've seen these young Millennials that, they don't get it. Like, they'll buy a practice that's doing eight hundred thousand a year but a hundred thousand of that was molar endo and now they go in there and they refer out all the endo, which you should have done the opposite, you should have bought a practice that referred all the endo, and then figured that into the price. You know, I want to go in there when I'm evaluating a practice - and practice brokers don't do this - how much money did you refer to who? Because maybe you're looking at it, saying, “Well, I'm not going to the work though.” Or maybe you look and say, “I'm doing Invisalign”, or whatever, but ...

Chad: Yeah, I think also some of the key factors in evaluating a practice is, you know, the first thing when I was looking at practices, I looked at the procedures that they were doing, because I remember there was a practice for sale that this guy was doing a gazillion mini-implants and that's just not my thing, you know, and he was doing a million Dollars a year, but I can't do that, because I don't really want to do mini-implants.

Howard: And why can't you do mini-implants?

Chad: Well, I could, you know, I just ...

Howard: You just don't believe in them?

Chad: I just would rather do regular implants, you know, and, so, it's just a whole different practice model.

Howard: Well, it used to be a huge price variant, the implant. But now the variance of the implant price, I mean ...

Chad: Yeah, I don't know a whole lot about them.

Howard: You can't really say I'm switching to mini just because they're so much cheaper.

Chad: Yeah.

Howard: I mean, yeah.

Chad: Yeah, so, I just, I mean, I looked ... because then I just ... you look at the procedures that are done, the percentage of procedures, I mean, yeah, if you're going into a practice at a ton of implants and you've never placed one, that's probably not a practice you should buy, or else you should learn implants first, you know, or else they're doing a lot of full mouth reconstruction and you don't know anything about occlusion and then you probably should steer clear of that practice. And another thing, a big factor is looking at demographics of practices, and one thing I kind of lucked out with this practice, is the demographic is probably mostly forty-five to seven year olds, which, those people probably need the most dental help, you know. And so, we get a lot of worn dentition, a lot of missing teeth, whereas you go into a practice that, you know, they're mostly twenty or thirty year olds, full practice, you know. So, there's a lot to look at when you purchase a practice, you know, and I think that just kind of scrapes the surface of, you know, what you should ...

Howard: I still think the best buy I saw in my lifetime here in ... since I graduated in '87, there was a guy a year after me, he was in '88, and he told me, he says, “You know, I really don't want to do endo, and I don't want to do ortho”, he says, “all I like is fillings and crowns and I really don't want to do anything other than fillings and crowns.” He shopped more dental offices than I'd ever seen anybody do, ended up going to Palm Springs. He found some seventy year old dentist who only did amalgams, MODBL's, he didn't do crowns. He patched everything for fifty years. This guy bought that practice and without doing anything, four of those existing patients a day, one of those MOB amalgams would crumble apart.

Chad: Yeah.

Howard: And he did four crowns a day just on emergencies, just on fifty years of clients coming in with their broken tooth.

Chad: Yup.

Howard: You know what four crowns a day is?

Chad: Oh, yeah.

Howard: By two hundred days a year?

Chad: Oh, yeah.

Howard: That's eight hundred crowns a year.

Chad: Yeah.

Howard: And this guy he had four operatories. He had one hygienist and he worked two rooms and had emergency. So, he's only checking one hygiene. Dude, he just sat in Palm Springs and just crushed it.

Chad: You see four patients a day and there you go.

Howard: Because he found a guy who didn't do crown and bridge, and he did crown and bridge, so, you shop. And what I like about ... you know, I got my MBA at ASU. They had a course on decision making. And the only really take away from that course is that, you know, you don't want to be emotional, you want to be data driven, you know. No decision's better than a bad decision. And a lot of people get so caught up in, well, they just want to buy a practice, their goal was to buy a practice this year.

Chad: [INDECIPHERABLE]

Howard: You know, or they just, they emotionally rush, Well, we should get engaged 'cause we, I mean, we've been dating a year. It's like, you know, you make up all this bullshit in your mind to make a bad decision. But the deal is that the square is the decision at hand. The triangle is the decision you went with. But the main thing I learned is the circles are all your options and people don't fill out circles.

Chad: Yeah.

Howard: For instance, let's say you want to go buy a house and your real estate agent shows a house, you like it, so you and your spouse buy the house. But if you would have look at every single house available for sale that fit your criteria of by your daughter's school, this and that, you might find out that you really overpaid for your house or underpaid or all things like that. And how many how many practices, how many circles did you fill out, how many practices did you look at before you bought your practice?

Chad: Oh, I mean I got a fairly lucky to find one kind of quick, but I still looked at probably thirty.

Howard: Yeah, thirty ...

Chad: And all the numbers, the demographics, the percentage of procedures they were doing, and that kind of, also will tell you if you get into a practice where they're doing, you know, four plus surface fillings and hardly any crowns, well those are going to bust, you know, and that's kind of where I got into too, is where there was a lot of patchwork done in the past and so these people come in with broken [...] or broken [...], you know, then, you know, like you said, you're just doing crown after crown, yeah.

Howard: So, you said another thing, when you bought the office, the one thing you did to it was to try to make it go paperless and you bought iPads.

Chad: Yeah.

Howard: For health histories, consent forms. So, I think it's funny. I love the term 'paperless dental offices'. Because whenever you go into an office that's paperless ...

Chad: There's paper everywhere.

Howard: ... you'll still find stickers, Post-It notes, so, tell us about your journey to paperless and how paperless are you?

Chad: Yeah, so, they were already ... had digital charts, I think for the previous five or six years, and so that was already in play. And so I mean but the problem is, is they still had individual charts for health histories, which to me, I mean, well, you've still got a chart, you know, and so, you know, my first thing was to do ... we got the Yapi service which, what that is is, you know, you can fill out your health histories and consent forms and health history updates on an iPad, and so that way you didn't need the health history at all.

Howard: And how did you find out about Yapi?

Chad: Just, I ... probably Dentaltown.

Howard: Gina Dorfman.

Chad: Okay.

Howard: Do you know who owns Yapi?

Chad: I don't know.

Howard: Her name's Gina Dorfman.

Chad: Okay.

Howard: And you're married. Are you married?

Chad: Yes.

Howard: Do you ever go hang out in L.A. or do you ever ...?

Chad: No, isn't he the ... Dorfman, the dentist out there?

Howard: No, Gina Dorfman. You're thinking of Bill Dorfman.

Chad: Okay.

Howard: The cosmetic dentist in Beverly Hills. Actually, he's in Century City, across the street from Beverly Hills 90210, whatever.

Chad: Yeah.

Howard: But Gina Dorfman has one of the most amazing dental practices I've ever seen in my life. She has two locations, probably thirty, forty employees and, but she ... do you know what Yapi stands for?

Chad: No, I don't.

Howard: Yet Another Practice Management Information System, you know what I mean. I mean, she's like, I'm really ...

Chad: I didn't know that.

Howard: ... am I really coming out with another one? There's so many of them. But, yeah, Yapi is ... so, why did you get Yapi and what do you think of Yapi?

Chad: You know, I ...

Howard: I'm sure Gina would love to hear your thoughts.

Chad: Yeah, yeah, and it could have been an impulse buy, I'm not sure. I just wanted a system that ... and it could have been from my website company too. I can't remember exactly how I heard about it.

Howard: Who's your website company?

Chad: Great Dental Websites.

Howard: Okay, Great Dental Websites.

Chad: Yeah, yeah. I wanted something that the patients could fill out their health history online before they came in and I wanted something they could fill, you know, consent forms and everything in-house, so we didn't have to have those paper health histories.

Howard: And what practice management system did you go with?

Chad: We have Dentrix.

Howard: You have Dentrix, and how do you like Dentrix?

Chad: I love Dentrix. We have Dentrix, and then we just, about six, eight months ago, we got ...

Howard: You love Dentrix. See that Dentrix? I have a guest on my show that says he loves you. Just because I can't stand you, doesn't mean that I don't have guests on my show.

Chad: Yeah, nice. No, I mean, I guess I don't have a lot to compare it to.

Howard: Well, Dentrix is a great system, they're the market leader. But the fact that they've stonewalled me for thirty years on hooking up to an accounting software - it's a mortal sin in the [...]. It's not a venial sin, it's a mortal sin, because none of these dentists know their cost because they have made a conscious decision not to hook up to your QuickBooks, your QuickBooks Online, your Peachtree, any accounting software, because any dental office I go to in the United States, you just got done checking the hygienist for a clean, exam and bite wings and I'll say, Hey, Chad! Chad, stop! Did you just make twelve Dollars and nineteen cents after taxes, or did you just lose eighteen bucks? And you're like, I have no idea. No idea.

Chad: Yeah, I guess from that perspective ... that's getting deep.

Howard: And the fact that, I mean, I flew to Provo to tell the original founder, I flew to Melville, New York, to talk to Stan Bergman, the CEO of Henry Schein, I flew to Effingham, Illinois, to tell EagleSoft, I flew to Minneapolis, St. Paul, to tell Pete Pershad, who is the CEO of Henry Schein that you have to fix this, your customer base is getting their ass handed to them on a platter because your practice management information ... how could it be a management information system when it's not hooked up to your accounts payable, your accounts receivable, and your check register.

Chad: That's true.

Howard: And they just say ... and you know what they all say to me? “Well, you're an MBA, you're sophisticated, you're at a different level. These guys, they don't understand.” It's like, “Well, maybe you should edu-ma-cate them.”

Chad: Yeah. But from what I know about it, it's worked well. But, you know, and I can go into the whole insurance thing. From what I understand, it's good with insurances and all my staff that takes care of that, you know, they love it, you know. So, that's kind of my experience and it works for me.

Howard: But what's your number one expense though in your office?

Chad: Staff.

Howard: Staff? Does it ... do your staff clock in and clock off on Dentrix and does it do payroll?

Chad: They clock in and clock out, then I do payroll through like ...

Howard: But why ...

Chad: I don't know.

Howard: How ... why do they not do payroll? I mean, is there a dental office they sold Dentrix to that doesn't have payroll? Have they sold Dentrix to one office where payroll isn't their number one expense? If I go to McDonald's ...

Chad: That's true.

Howard: ... I clock in and off at the damn cash register and then at the end of the day, it'll ... not only will it do my payroll, it'll say, “Your labor costs for this McDonald's today was nineteen percent, you know, and your food cost was thirty one percent.”

Chad: And, yet, you know, you say, I think that's beyond a lot of dentists, to be honest with you.

Howard: I know, and a lot of dentists ...

Chad: It's sad but it is.

Howard: ... should not have gone to dental school. You know, my dad was so mad when I wanted to go to dental school, because he had Sonic Drive-Ins, he was like, “Howie, that eight years it'll take you to be a dentist, you could have three or four Sonic Drive-Ins. You could be a millionaire before you go to dental school.” And my walnut brain's like, “I know, Dad, and I love you, but I don't want to make cheeseburgers. I want to fix teeth like my next door neighbor, Kenny Anderson.” I'd go to work with my dad and we'd make chili dogs, and I'd go to work with Kenny Anderson, and we'd make root canals and crowns. And I just told my dad I wasn't going to spend forty year making chili dogs. But, my g*d, my dad, his cash register when I was ten years old - 1972 - ten years old - was National Cash Registers. There was more financial business information out of that cash register, when I was ten, than there is out of Dentrix when I'm fifty-five years old.

Chad: Yeah.

Howard: That's ... anyway ...

Chad: Yeah, I mean, that goes into, you know, the whole thing ... whereas, yeah, you see these ... some of these, especially these new PPOs that are offering forty Dollars for a cleaning and you're paying your hygienist forty-five an hour. It doesn't make any sense, like you say, you just lost money, you know.

Howard: So, yeah. So, what is the going rate for a hygienist in your area?

Chad: Thirty-six, forty-five, you know. depending.

Howard: Thirty-six to forty-five.

Chad: Yeah, depending on experience.

Howard: And what is going rate for the price of ... and what are insurances paying dentists in the Valley for a [...].

Chad: I don't take a lot of the really bad ones, but I'll get these fee schedules coming across my desk and it's, you know, I'll see forty bucks, and I'm like, I can't do that.

Howard: But which ones are you accepting though? I mean ...

Chad: Not those!

Howard: But what are you accepting?

Chad: Our lowest one is Delta Dental.

Howard: And how much are they paying you for a profi?

Chad: I think it's around like fifty-five.

Howard: Okay, so, exactly. So, I'm paying ... so, hygienists are, you say thirty-six to forty-five?

Chad: Yeah.

Howard: And Delta's paying you forty Dollars for a profi?

Chad: They're paying a little more than that.

Howard: Okay, let's say forty-five, but the bottom line is this, financial accounting is void in Dentrix and EagleSoft, managerial accounting is void Dentrix and EagleSoft, and this game with corporate dentistry, how many corporate dental chains are in this area? They buy ... their practice management systems, they hire a bunch of programmers and add on, like Pacific Dental. I mean, what Steve Thorne has done, is he's bought ... he bought an existing practice management software back in the day and then his programmers have added layers and layers and layers and you're competing with people who know if they, to the penny after tax, what they're making, and these dentists have no idea what they're doing. And then you say to them, “Well, what are you going to do this weekend?” “Well, I'm going to go to a bonding course, and I'm going to go listen to Gordon Christensen, he's going to review all the bonding agents.” And I'm like, “Is that really your problem? I mean, are all your composites falling out?”

Chad: Yeah.

Howard: “Well, I want to know the wear rates?” “Is that your problem? Are all your fillings wearing down? I don't think your problem is your fillings are falling out and they're all wearing down. I don't think you have any idea where you're making or losing money.”

Chad: Then, yeah, on top of that you'll see people offering free exams. Free, free, free. I don't know how they do it. I don't market at all. I just do word-of-mouth, you know, and I don't know how some of these guys can afford to, you know, just shell out free this, free that, you know, to the freebie crowd and not know their bottom line, like, well, what's that costing. I mean, I don't know. I make [...].

Howard: Well, another thing you used ... you use Weave.

Chad: Yeah, I use Weave, I love Weave too.

Howard: Well, tell my homies ... you talked about you use Yapi.

Chad: Yeah. Used Yapi to go paperless, even for consent forms and health histories.

Howard: And you like Yapi?

Chad: Yeah. I mean, it does ... yeah, and you can ...

Howard: I can assure you from Yapi that that is ... that Gina Dorfman - what does she go by, Gina Dorfman? It's her cat's name. Is it Mooki, Moki, Muffy?

Ryan: It's, oh, gosh, I need to look it up. I don't remember.

Howard: On Dentaltown she goes after her cat's name.

Chad: Yeah.

Howard: Gina Dorfman, probably the most well ran practice management consumer experience, probably dots the i's and crosses the t's more than any single person in dentistry, and then you also bought Weave, which is out of Provo, which is an interesting area. You think of Silicon Valley, but in Utah they call it Silicon Slopes. There is more dental companies out there ...

Chad: It seems like it.

Howard: You've got Weave, Dental Intel ... but, why did you buy Weave and what do they do for you?

Chad: Well, we needed a new phone system, because when I got ... you know, came on board and bought the practice, their phone systems were just, I mean, they just needed new phones. I mean, they were twenty years old, I think. And, so, I had I heard about Weave through different CE courses, you know, they'll have their reps there and they'll give their whole spiel, and I looked more into it. But, you know, it was going to cost about the same amount as what the current phone system did. And so, what I like about Weave is that, it has ... it's, you know, software-based where it has all of your patients in Weave. It's connected to Dentrix, and so it'll pop up ... when they call, it'll pop up their name, it'll say if their family member's due for re-care, if they're due for re-care. And you can also ... probably the biggest thing I use about it, is, I mean, it records voice mails into where I can go on there and like log me in through my computer and I can listen to the voicemail I needed to, or I can listen to a phone call. I mean, I don't use it to punish staff or anything, but ...

Howard: So, but, it records your patient phone calls?

Chad: Yeah. And so, what I can do is if someone says, Oh, well, so-and-so said on the phone ..., or Oh, did they call this patient, you know, because they have a balance, I can just type their name into Weave and I can see just at least the call history and listen to the call, if that's needed. And a lot of the time, the girls upfront will use that just to say, “Oh, what did we quote that patient”, or, you know, “What did we tell this patient?”

Howard: But here's the more important part of that. When your staff just knows that you're recording the phone calls ...

Chad: Oh, yeah, absolutely.

Howard: ... I mean, the studies show that when you're in retail and you put a hidden camera over ... I mean, a visible camera over the cash register, it stops ninety nine percent of internal peculation, stealing, theft. Casinos put them everywhere because Las Vegas attracts a wild crowd ...

Chad: Oh, absolutely.

Howard: ... and at least one percent of that crowd are sociopaths. But when they're sitting there, and they see all these cameras out there, even though there might not even be a human looking possibly at every one of those cameras. So, but, a dentist again, I'll say, “What are you doing this weekend?” He says, “Well, you know, I'm going to take this this bonding course”, and I'll say, “Well, how many incoming calls did you have last month?” Doesn't know. “How many went to voicemail?” No idea. “How many of the voicemails were never even listened to?” No idea. And what does he think the problem is?

Chad: His bonding.

Howard: His bonding agent.

Chad: Yeah, that's why Weave is great because I mean I can see ... you know we have ... we can easily forward things into a cellphone over the weekend or I can just log on, you know, through to my computer from home and I can see the numbers that called and what we missed. And I can, you know, listen to the phone call or, you know, see what the voicemail says, see what the concern is and, you know, if someone else is [...],I can get on and call them.

Howard: And how much is Weave?

Chad: It's like three fifty a month. I think that before they were paying about like six hundred.

Howard: And how much is Yapi?

Chad: One ninety-nine, or two ninety-nine, I think.

Howard: So, you're paying two hundred a month for Yapi, and you think that's a good buy?

Chad: You know, I haven't price-compared a lot of the services that are offered, you know, I think ...

Howard: I think it's a great buy. Do you think ... what about Weave?

Chad: oh, I think it's great. I mean, because if I was paying that for an analog service and a digital software service is the same cost, but for more options, I think it's definitely worth it.

Howard: Yeah, I think the most sophisticated practices I know are on Weave, they're on some type of demographic deal. What's the other one we did the other day?

Chad: There's a lot.

Howard: Yocale?

Ryan: Practice by Numbers.

Howard: Practice by Numbers.

Chad: Yeah.

Howard: They're on Weave, Practice by Numbers, something like that. If they're crushing it in the new patient - I don't like the term 'new patient experience' because it should be overall five-star customer experience. I mean, the Hyatt Regency doesn't treat a new customer to Hyatt Regency, they're concerned about the businessman, they want to keep their customers for life. They're using Yapi. And my favorite software is actually Open Dental, simply because since it's open, you can actually start doing your own programming to your own accounting software, or at least is open to where you can start bridging it yourself.

Chad: That goes beyond probably ninety nine percent of most dentists, I'm guessing, you know, just being able to program things, and maybe not, but, yeah, that's intense stuff.

Howard: Well, I am so excited you came by.

Chad: Yeah.

Howard: Thanks for being a Townie. Big fan of your four hundred posts. That's so cool, you're up the street. I'm sure you're an amazing role model for so many young dentists and thanks for coming by the house on a Friday when you'd probably rather be out golfing or ...

Chad: Nah, it too hot for that right now.

Howard: Oh, it's too hot for golf?

Chad: Yeah, this time of day.

Howard: So, do you like Phoenix?

Chad: Oh, we love Phoenix. You know, someone ...

Howard: What do you love about it?

Chad: Well, really the whole city. You know, we wanted a city where it wasn't a lot of traffic and you know there's a lot of things to do, hiking, we're close to California, close to Vegas, close to Mexico. Airport's great. A lot of non-stop flights.

Howard: And what's the worst thing about it?

Chad: Being far away from family, probably.

Howard: And where's the family? Iowa?

Chad: Iowa and Ohio. And then the heat, probably, but, you know what? Every place ... if it was great ...

Howard: And you're married, but you don't have kids?

Chad: No kids, no.

Howard: Yeah. But, you know what he didn't say? He didn't say, the heat. And you know why he didn't say, the heat? Because he's from Iowa. So, a lot of people say, Man, it's so hot in the summer. Well, in Kansas -and I went to Creighton in Nebraska and dental school in Missouri. I mean, Ryan, when we were ... last time we were in Missouri, after the seminar, we went to one of the dentist's houses, George Ruwwe, and hung out on his boat and Lake, and what happened to us?

Ryan: Just eaten alive.

Howard: Eaten alive by chiggers. We looked like we had chicken pox. When I grew up in Kansas, every time we'd go out in the back and charcoal hamburgers, and all this, the chiggers would eat the bottom one foot of your leg.

Chad: Oh, yeah, I know how that goes.

Howard: And this is ten degrees hotter, but there is no humidity and there's no insects. I could go lay in my backyard grass, just lay in the grass naked, and I mean unless there was a scorpion or a rattlesnake, yeah, you're good.

Chad: As you go up, you know, an hour and a half north up the flag and then, you know, it's green.

Howard: And I lectured in Belize last year and took two of my boys with me. Oh, my g*d, that's insects at a different level and I was so glad I took them, because I took Graig and Zach with me, and they were like, Dad, I will never complain about the hundred and fifteen degree Phoenix because the hundred degree on the Equator ... I mean, you would walk on the beach and you'd see like a funnel of these insects. And the locals are saying, you know, “Don't walk into these deals”, and you'd see like a tornado funnel of insects and the bizarrest thing I saw, this was so sad. When we were staying at this resort, this couple was on their honeymoon in Belize. You can't make this sh*t up. The first night they're there, they're walking along the beach - it's the full moon, having a romantic honeymoon deal - and they walk into something and they're bitten like, you know, three hundred times. The whole honeymoon they're laying on their bed while the staff is putting calamine lotion all over their body, nursing these, you know, just, I mean, they were just eaten alive. And that's what I love about Phoenix, I mean.

Chad: There's, you know, it's got the heat but, you know, if it had great weather year around everybody would be here and we'd run out of water.

Howard: Well, again, thanks for being a role model.

Chad: Great, thanks for having me.

Howard: Thanks for being a Townie. Thanks for coming on the show ...

Chad: Yeah, thank you.

Howard: ... and sharing with all these Millennials your secret sauce.

Chad: Yeah, right, thanks a lot, Howard.

Howard: Thank you, buddy.

[END OF TRANSCRIPTION]