Dentistry Uncensored with Howard Farran

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Penny Reed is a dental practice management coach, professional speaker, and author of the book Growing Your Dental Business. 

Penny was recruited by her dentist to run his growing practice in 1992 and began her career as a dental consultant in 1994.  She has been designated by Dentistry Today as one of the prestigious Leaders in Dental Consulting from 2007 to 2017.  She is a member of the Academy of Dental Management Consultants, the Speaking and Consulting Network and is an ASCA member of the American Association of Dental Office Managers.  She coaches dentists and their teams and has spoken to dental groups nationally for over two decades.

On a personal note, Penny is a major Disney fan and is always plotting her next Disney trip or dental retreat near one of the parks.

www.pennyreed.com

www.attitudeupgrade.com

Howard: It is just a huge honor today to be podcast interviewing a friend, a role model, an idol of mine for decades, Penny Reed. How are you doing Penny? 

Penny: Awesome, awesome. Great to be with you, Howard. 

Howard: Penny Reed is a Dental Practice Management coach, professional speaker, and author of the book, ‘Growing Your Dental Practice’. It's a must read. Penny was recruited by her dentist to run his growing dental practice in 1992 and began her career as a Dental Consultant in '94. She has been designated by Dentistry Today as one of the prestigious leaders in dental consulting from 2007 to 2017. She is a member of the Academy of Dental Management Consultants, the speaking and consulting network, and is an ASCA member of the American Association of Dental office managers. She coaches dentists and their teams and has spoken to dental groups nationally for over two decades. On a personal note, Penny is a major Disney fan and is always plotting her next Disney trip or retreat near one of the parks which explains why this weekend, the AADOM, the American Academy of Dental Office Managers had a two day seminar right here in Phoenix and your lecture was called Dental Metrics and the Wizard of Oz. Is The Wizard of Oz, that's not quite Disney? 

Penny: It's not quite Disney but it's a story and it's always an honor to get to speak at AADOM. I spoke last for them ten years ago in Minneapolis and that group is growing like crazy. 

Howard: AADOM? 

Penny: AADOM is, yeah, the American Association of Dental Office Managers. 

Howard: And why do you think it's growing like crazy? 

Penny: I think because having been an office manager and especially at the time in '92 I was one of the few office managers that had a business degree. I had been in management with Walmart so I understood what it took to run a business but I didn't understand what it took to run a dental practice so there was no place to go. I remember asking my dentist, "Well, do you have any books? Is there any place...?" I mean if the Internet had been invented yet, we didn't have it. So he handed me a big, I think it was a Perio textbook and it didn't really help, right? So we didn't really have any resources and I - the AADOM group - it's just amazing all the resources they have and that they can come together and learn these things and share with others that have similar challenges and issues. It's brilliant that Heather Colicchio put it together. I wish I had done it. 

Howard: We've had Heather on the show. I'm a big huge fan of hers. I think what she's done - she had me speak in San Diego. She's just amazing. And every dentist I know that told his office manager, "You go get your fellowship at the American Academy of Dental Office Managers or FAADOM." And they said it was totally worth their return on investment. In fact, I' even did a monthly Howard Speaks column on it. So big promoter of her. 

Penny: Well and I recommend every client of mine that their office manager join. Which by the way I know we'll get to some things at the end of the session. Anybody that's listening that is an office manager or doctors if you're listening and you're thinking about AADOM for your office manager, my e-mail super easy penny@pennyreed.com. I know it will be probably at the end of the information. I actually have a referral code that I can give to those office managers that makes their first year's dues minimal but it is a fantastic organization. Webinars, great resources for them. 

Howard: And if you say Howard sent you, they'll deny your application. 

Penny: Yes, yes. 

Howard: But so back to your title, Dental Metrics and the Wizard of Oz. What - where the Wizard of Oz? I love the Wizard of Oz. I was born and raised in Kansas that's so... 

Penny: Yeah, well I love it too. And so what happened was they asked me to speak on knowing your numbers right, which I enjoy talking about that. And when you're talking with a practice directly about their numbers they're interested in the numbers. When you're talking about numbers in general, after a while - I mean, because you know. You talk about numbers. People's eyes may tend to roll back in their heads so when they said, "Send in your program descriptor," I looked at it and I was like, "My course descriptor sounds boring," and they said make it exciting and engaging and so in my mind when you think about the Wizard of Oz we all think about all the positive stuff first, right? The beautiful colorful Munchkin Land, Dorothy, all the neat parts. But that was really a scary movie. I mean if you think about it that's probably one of the most disturbing children's stories out there, right? 

Howard: Well do you know the meaning of the movie? 

Penny: Well I may not know the meaning of the movie as you know the meaning of the movie. So you tell me. 

Howard: Well when I got my MBA at Arizona State University, the Ph.D. economist was explaining to us that back in the day, it was it was just modern that you could bad mouth the president. 

Penny: Right. 

Howard: Like the guy who wrote Puff The Magic Dragon. When the King found out about him and he was quartered. 

Penny: Oh wow. 

Howard: Where they get four horses, tie your arm, leg, snap the horse pulled apart. Nobody ever was brave enough to say anything to a US president for the first century and so you had this - you had the Northeast manufacturing, the Tin Man, and you had the farmers, the scarecrow. 

Penny: Okay. 

Howard: And you had the Congress, the Cowardly Lion. And the farmers wanted deflation. No, no the Northeastern manufacturers wanted deflation, it'd help their exports. But it would kill the farmers trying to pay down their debt. So the Northeast wanted to take - the gold supply was fixed. Being on the Gold Standard took away all of your tools like we have today with the money supply with the Federal Reserve. So we were stuck on the gold standard. So the Northeast wanted to take the silver and dump it in the gold and deflate the money, lower the dollar, print more dollars, help exports, and so the Yellow Brick Road - in the book she had silver slippers. 

Penny: Correct. Right. 

Penny: But in the movie they didn't show up on black and white so they had to go to ruby. 

Penny: Yeah. 

Howard: Which is so dumb. She had silver slippers. She's walking - that silver - she's walking the gold brick all the way to the Emerald City which was the greenback which every state had its own currency until the Civil War. Lincoln didn't know how to pay for this war, so he mandated that states had to roll their currency into the greenback - Emerald City the greenback - so he could just print money counterfeit to pay for all that deal and it was just - so it was an intellectual movie - book. And all the intellectuals read it and all the intellectuals knew the meaning of it and the president and the Congress knew the meaning of and it was letting them know what the people thought. 

Penny: Isn't that something. You know what I'm thinking like as you're telling me all of this. Do you sleep? You probably are one of the most... 

Howard: Wow. 

Penny: ...read people that I've ever talked to. No it's. 

Howard: You know what, it's a habit. I just don't read fiction. 

Penny: Yeah. 

Howard: That's all it is. 

Penny: Yeah. 

Howard: I don't read fiction and I don't watch TV. 

Penny: Yeah. Well you could definitely get a lot done. 

Howard: Yeah. 

Penny: Like that for sure. So when you think about the story part of it, right, because people learn and are more engaged, at least I am, if there's some sort of story behind something or I lose interest. So I thought, "Well what can we do to engage them?" So most of the time what prevents us from learning and tracking the numbers, sometimes it's fear. Right? We're afraid of what we're going to find or we're afraid maybe we're not smart enough. Or if we do see something as an office manager or even as a business partner in a dental practice we may not have the courage to point out what that is. It - all of a sudden we bring that up. Now we've got to deal with it. So often what happens is, it's the flying monkeys. That was how I tied a lot of that in, right? 

Howard: Yeah. 

Penny: So, it's like, "What are some of the flying monkeys that you have in your practice?" "I have a doctor that doesn't want to know the numbers. My doctor doesn't want to know the numbers. Can you help me with that?" I was like, "We need to talk about that after." How do we prevent broken and canceled appointments? It was like they really got it that one of the reasons they don't track the numbers - I said, "You will say we don't have -" What do you think they say? "We don't have blank to track the numbers." Time. 

Howard: Time. 

Penny: And so part of it was also being intentional. Be ensured that we're staying on the yellow brick road. So from that perspective of the program it was more of an analogy and you know in keeping them engaged and they had a lot of fun. And most people came up after and they said, "This is one of the best programs I've ever heard on numbers because I was able to stay involved," and it was a blast. It was probably the most fun I've ever had presenting the numbers because we got to play with it. It was a lot of fun. 

Howard: And a follow up on the Wizard of Oz, the favorite play I ever saw my life was Wicked. Did you see that play? 

Penny: I haven't seen Wicked. 

Howard: The Wizard of Oz starts with these characters. So this guy went back and said, "Well, where'd they come from?" So he developed the characters. And you know when you go to like, say some movie you've already seen and they do a play you know the whole plot. But this was so fun because you know the Wizard of Oz, but you don't know where the characters…. it was the most amazing play I'd ever been to, and at the end it was the only play I've ever been to where the whole room jumped to their feet. 

Penny: Wow. 

Howard: In applause for like ten minutes. 

Penny: I mean I've heard - I love the music. 

Howard: Oh my God. 

Penny: So that's on my bucket list to see Wicked. 

Howard: It was just crazy. You know, back to the numbers. You know my book was People, Time and Money. I think HR is everything. And I always think that when I study neural anatomy they're pretty convinced that pretty much everybody has the same brain, I mean if you dissected a hundred dolphins, a hundred ants, a hundred chimpanzees, and a hundred humans, unless you got a tumor or something... 

Penny: Right. 

Howard: We all got the same iPhone. So it's just - you know they say, "Well this girl is a genius." I went and watched watch that genius violinist, and she was amazing. But she played four hours a day since she was age four. 

Penny: Right. 

Howard: I don't want to play the violin four hours a day. So she's not a genius. She was heavily interested in the violin. And when people say to me they suck in math or they hate numbers and they're just not interested in it. So I think if you're interested in something four hours a day every day your whole life you're going to be a genius in it. 

Penny: Absolutely. 

Howard: And like they tell us the two smartest people in the world were Sir Isaac Newton in 1687, the principles of calculus and then Einstein in '21 with relativity. But again those - if you study those two people, they were freaks. I mean gosh darn Sir Isaac Newton took all the money from his book... 

Penny: Right. 

Howard: And invested it all in tulips. The tulip bulb bill which is the first equivalent of investing in gold. I mean there's no difference investing in tulips or gold... 

Penny: Right. 

Howard: And lost all his money, but he's the smartest guy in the world. Einstein married his first cousin and when he got his Nobel prize money he gave it all to her if she would change her name and go away and not tell anybody that he had married his first cousin. But why were they so genius? Because who the hell else was studying physics in 1687... 

Penny: Sure. 

Howard: And 1921. So since they were the only one interested in it, they're a genius. But if you know all the baseball scores. Going back to Babe Ruth then you're just a dummy. 

Penny: Right. 

Howard: You're just a Wal-Mart-er. 

Penny: Right. 

Howard: You know, you're just a beer drinking dummy. 

Penny: Right. 

Howard: Because if you're interested in something that everyone's interested in, there's no value. That is why in my lesson on H.R., which I think you know if you're on a football team you just want the best players. 

Penny: Absolutely. 

Howard: You have a dental office. That's why I look back at my thirty years. Every time I hired a bookkeeper, you know the girl coming into work in healthcare... 

Penny: Right. 

Howard: Wanted big bucks, but the little bookkeeper, she's one of like twelve. But the, "Well I've got ten years’ experience in dentistry. I want twenty three dollars an hour, or twenty seven dollars an hour." And then I'd say, "Well what practice management system you've been on?" "Dentrix" "How long have you been on it?" "Ten years." "Do you know it good? Good. Good that's great. How many reports does it run?" No idea. 

Penny: No idea. 

Howard: And then you start asking her basic report - and then the girl I hired from Chase Bank. Oh my God. So taking a bookkeeper or girl from Chase Bank and teaching her what a filling, crown and root canal is was easy. 

Penny: Absolutely. 

Howard: Taking a girl that had no interest in numbers and teaching her numbers was impossible. 

Penny: Right. Right. And I think you've hit upon - and in the last part of the presentation when we recapped the numbers and I said, "Take a look at this particular slide," because it talked about was being intentional. Right? In planning and having that time I said, "What you know about the numbers is important. It's having the self-discipline and the focus is what's most important. And then also involving the team because what office managers tend to do, most of them, especially if they were promoted from within, they know how to do everything in the office and they're great at it. So they become professional firefighters instead of learning how to empower the other team members." So when I think about what had me write this book and put these systems together, it was a passion to provide a resource on how to grow a practice and you and I have done a previous podcast. There's a blueprint in there to grow a practice by 25 percent. So. I believe today with Dentaltown, the conferences now that are available, the books that are available, there is no shortage of information on how to do things. Now that doesn't mean that that information is not important. But it used to be you could find it, right? It was like trying to look for a needle in a haystack. So when I really think about what we need most in dentistry and where we're heading, you know a thought hit me and that's that practice management as we know it is dead. Right? I mean it's - back in the early '90s, we were so hungry for information. Right, it was like, "Well if we can just find how to do this." Now I watch dentist, and I know you and I have talked about this before, dentists, office managers, in a constant, I'll just call it like spinning or twirling, "Okay well I need to go take this course. You know I need to learn how to do this procedure. We need to add Botox and Juvederm. We need a CEREC, we need a CAD/CAM. We need E4D." All those things are great but if you don't have a culture and an environment in place where people would utilize those things and that places value on the patients over the, "We're smarter than everybody else," you struggle. And then you go from one consultant to another, I mean sometimes I'm office's first consultant. Sometimes I'm their fifteenth. And boy you know when you're the fifteenth depending on where they are. Like if they're in the top you're like, "Okay, this is a group that can take what they learn, they can apply it, and this is going to be so awesome." If I'm the fifteenth consultant and I look and this practice is struggling, it's not that they don't know what to do. And that's really like the heart of my message now. It's like, "Okay, I'm about to be fifty. And what is it that I really want to help practices with?" I love practice management. So you know, to say that it's dead. You could say, "Okay Penny, is it really?" But without a high level of coaching, it is. And I don't mean, "Oh hey hire me. Or you know find somebody - find another coach that you like better, hire them. I do believe you need a coach. I have a coach." What dentist and office managers, team leaders really have to have is they have to learn how to coach. They may not want to, right? But if you can't get people to do what you want them to do, not because you pound your fist on the table and say, "You know, do it this way or there's the door." If you can't get that buy in, if they don't know what your expectations are they're never going to be able to - it's the sustainability. Right? They'll do something for a little while and then thirty days later they quit. So if you feel like you're having to babysit your team that's an issue of a bigger problem, right? That's not the issue. The system's not the issue. It's the environment that's the issue. So I'm curious what your thoughts are about that and what you think of when you hear the word culture. 

Howard: Well I'm - it was very profound you said about these office managers are firefighters because they've done everything. They're cross-trained everything and I would say whenever I see an office manager, they're answering the phone, or scheduling patients, or greeting patients, or putting out a fire, they're doing something. They're working in their business. And I don't see them sitting in their private office going long, restructuring, any planning. I mean one of the most classic books in the world was Behemoth. 

Penny: Oh absolutely. 

Howard: Because here's mom and dad, they had a restaurant in Parsons, Kansas for forty years. They were born in that town, they went to church there, their kids went to high school there, everything there. And McDonald's comes in, sets up right next to them, and they're out of business in ninety days. And everybody would know that just doesn't seem right. That's a big deal to corporate dentistry. 

Penny: Right. 

Howard: You know I mean this is a family owned restaurant. And the deal is they work so hard making a hamburger, fry, and a Coke. Nobody ever thought, "Why does it take an hour to get a frickin’ hamburger, fry and a Coke?" 

Penny: Yeah. 

Howard: And so here's McDonald's. Here's Ray Kroc. Here's these guys, and the movie The Founder was I think the best movie I've seen in years. What was that guy's name, Keating? 

Penny: Was it Michael Keaton? 

Howard: Michael Keaton. Michael Keaton. God is good man. Because I met Ray Kroc. 

Penny: Oh wow. 

Howard: My dad had nine restaurants in four states and man, that was the greatest movie. Because it was all systems. And he had these franchisees that say, "Well we want to add pizza." I mean imagine if McDonald's sales were going down. And their answer was, "Well we can't make money on a hamburger, fry and a Coke. So we're going to add microwave burritos and a pizza." You'd say, "Are you out of your mind?" Look at car companies. Look at so many of these car companies realize, that have sold off their high end cars. I mean it used to be all Ford had some, the nicest - what was - Jaguar. 

Penny: Oh yeah. 

Howard: In the U.K. and they all have these high end cars they realized it was such a just - they don't make any money on a Jaguar. They don't make any money on Botox. You don't make any money on TMJ. They don't make any money adding all this bullshit. They sit there, you're doing a cleaning, exam, x-rays, fillings, crowns, and there's ten thousand dentists who do a million a year and take home three fifty that don't do molar, endo, pull wisdom teeth, place implants, have the CAD/CAM, have a CEREC. What they have is they have their damn business in order. 

Penny: Absolutely. 

Howard: And what the car companies found out is, you know all their hot engineers wanted to go play in Jaguar and they'd be having a meeting and half it would be on this Jaguar. It was like one percent of revenue. Like I'll meet someone who goes to one of these big occlusion places you know once for a weekend, six times. I would say well what percent of your practice is TMJ? Number one they don't know and number two, you know it's one percent. 

Penny: True. 

Howard: And you know many people I know that have flown all around the world to learn about sleep apnea? 

Penny: Oh. 

Howard: It's still one percent. And so my deal is, I want you to be passionate. If sleep apnea and occlusion and TMJ, if that's your passion. Amazing. 

Penny: Go for it. 

Howard: You know you know what you should do with a passion? You should first be rich so if your passion is camping you can buy a camper and a boat. 

Penny: Right. 

Howard: And if your passion is traveling - so get your damn house in order. I mean and if you can't make money in dentistry on cleanings, exams, x-rays, fillings, and crowns, and simple endo, simple extraction -nd if you can't do a million a year on the basics. 

Penny: Oh absolutely. 

Howard: Because you know I look at that little girl who's up there and they're conducting the orchestra I mean if she needs a cello she's not going to go to the Cello Institute and get her fellowship in the Academy of Cellos, she'll just find someone. I mean these big boys like that though they'll go find that they don't want to learn how to place implants. They'll go find a periodontist in the next county and they'll stack them all up on a Friday, pay them 50/50. And he'll come in there for a patient first, their records are here. He'll come in there on a Friday once a month and place eight implants for eight grand. 

Penny: Absolutely. 

Howard: And the dentist will make four grand while he's sitting on the golf course. I can - so you know I just think that restaurants are the most brutal business out there. 

Penny: Oh absolutely. 

Howard: It's about 80 percent two year failure rate and no one's ever analyzed a restaurant and say, "Well the problem with your restaurant is you didn't have a bunch of alphabet stuff behind your name and you didn't have fettuccini alfredo. 

Penny: Right. 

Howard: It was basically, you didn't know your numbers. 

Penny: And you didn't have great service. And it's funny that you mention, because you know all those services are great. I mean, treatment of sleep apnea, the TMJ. It's not that the services aren't great but if you look at the reason behind - you know it's probably the 80/20 rule. What motivates most dentists to do that, is they see it as - I call it - it's like the quick fix. Right? Like the crack hit. So I can go do that. I'll make a whole bunch more money and it'll be easier. I mean that's what they're being sold by a lot of these companies. 

Howard: It's a silver bullet. 

Penny: And then they go. Yeah they go... 

Howard: It's a silver bullet. 

Penny: And they take the course. And one of my top producing, most profitable clients, who by the way doesn't do any of that stuff that you just talked about, right? 

Howard: Right. 

Penny: Just bread and butter solid, knows how to treat people. We were talking and he said, "You know what?" We were talking about something big and easy. He said, "What worthwhile in business or in life is easy?" And I thought that's one of the most brilliant things that I've ever heard anybody say. And it's from a dentist who you know he hasn't done any of the smoke and mirrors kind of stuff he's just a basic smart business man and great at relationships. And so when I look at - because it does frustrate me. If I work with somebody and I teach him these things it's not an ego thing for me that they may not do when I teach him to do. It's painful for me. It's like watching your patient who, they come in and you're talking to them it's like, "Oh my goodness. You know, you've got to floss. Take a look at this." You know you're watching them let their teeth rot, you know, just rot out of their head. Right? And they're thinking, "Well if I just use a different toothpaste or if I use this mouthwash I won't have to floss." Well that basic fundamental piece of it when it comes down to the culture and you're talking about having their house in order, even if they know their numbers, with the volume now that a lot of practices are doing and you could probably remember when your practice was smaller to when the business gets bigger. When it's smaller, the culture part's easy. 

Howard: Right. Oh yeah. 

Penny: I mean if you've got four operatories and you can see every single room and you hear every conversation that's going on, you've got your finger on the pulse of what's happening. So now you've got eighteen operatories, three other dentists, everybody's wearing a radio, half of your team's - the phone's being answered upstairs, the phone's being answered offsite. So that's where - and when I think about culture and it's pretty exciting because I'm now being asked to talk about it, which is - by Dental Associations because most of the time that's like, "What is that?" So scientifically you culture something in a petri dish. Right? I mean we can all relate to that. You think you have strep throat, they put the three foot long Q-Tip in the back of your throat, and you think you're going to die. And then they put it in the dish and they look to see what grows, right, in the environment. So in a healthy culture you could think, "All right. Well you could see like a beautiful plant or something growing in that culture." In a culture where it's not healthy where, there's more dysfunction present you know, like to give a visual, it's almost like there's these amoeba, you know germy bacteria growing in there. So if you could take that analogy and put that in a business, how much more does it help you to know how to schedule better, or what your overhead is, or how the phones are being answered? If there's that disease present you just keep working harder and harder, right? You go to one seminar after another. You add that much more of the different treatment modalities to your business, when the true issue is you haven't defined for your team, however big the organization is what the beliefs, values, and behaviors are that are appropriate. And I'm not talking about a POP. I know businesses need a policy manual. I'm not talking about that part. I'm talking about the owners saying, "Here's how we want you to treat people. Right? Here's what's appropriate and what's not appropriate. These are the values that are important. This is why I want you to answer the phone this way." This is why I loved when you were telling me when the older ladies come in your practice you not only like hug them and kiss them on the cheek right? like you're like kissing them on the mouth. You know it's a... 

Howard: If they're over eighty. 

Penny: Yeah. 

Howard: Hell yeah. 

Penny: Yeah, they're your girlfriends, right? 

Howard: Yeah, yeah. 

Penny: So it's that part of it and then everything else grows from that. But what happens is, and Howard I'm here to tell you, I made every mistake probably known in the book as an office manager, as a consultant. And those are the best teachers, right? It's the clients that you come in and you sense that the culture piece is wrong, but they're like, "We'll worry about that later. Help me with the systems." Well what do you think what ends up happening, right? And then I wind up kicking myself. We go systems, systems, systems, and then the next thing you know you're in the office and you realize that you've got a partnership that's about to explode. Right? You know the doctors are at each other's throats. They haven't even defined how they're going to work together, and it just flows down to the team. So defining the culture is part of it. Then you've got to share what the expectation is. You've actually got to overshare it. We were talking about Disney and oh my goodness I love Disney. I have a friend that the Disney Institute facilitator and so we were talking and when they hire new people on, it doesn't matter what their role is as a cast member. They get through something called Traditions, and it's two or three days where they talk about the history, and the culture, and how things are going to be. So you're indoctrinated into that from the get go. Then after every so often I don't know if it's every two years or every three years, you go back through Traditions. So they're keeping that in the forefront. And it's not just because I'm a - I mean I am a Disney nut. But part of what works so well with that organization, and it's got flaws right just like every other business has some flaws, is they have managed to replicate it in different cities, different countries. And as a customer or as a guest you still have the same experience. So you look at these dental offices. Right? Well we're doing great in this one office. Let's open a second one. Oh the second one works pretty well. You know if we were thinking about you, well Howard you could work a couple of days here, a couple of days there, so you are the driver of the culture primarily. Right? So you're in both places. Well now we do location three, location four. Right around location three, especially location four, if that culture isn't in place, location three and four, they're - Have you ever seen the movie Multiplicity, with Michael Keaton where he clones himself? 

Howard: I did not. 

Penny: It's probably a B movie. It's hilarious. Like it's just one of those dumb movies that you should watch. So there's not enough of him to go around. 

Howard: Michael Keaton, the guy that was in The Founder? 

Penny: I believe - well it's Michael Keaton. So I think that's who was in The Founder. 

Howard: Yeah. Oh yeah. 

Penny: So he comes himself because he needs to spend - his marriage is bad. He clones himself and it works great because one of them is at home doing all the honey-dos and the other one is at work. Well the clone decides to clones himself. So the third clone is a little bit off. Well by the time you get to the fourth clone, I mean like he's special like he's nothing like the first one but it's a goofy analogy but I watch it happen. These gods it's like oh my goodness yeah we're going to do that whole entrepreneurial thing and there's nothing wrong with having multiple locations but you not only need to have that first location in order you've got to have everything in place so that if Howard's not there, right, if you're that dynamic driver entrepreneurial person, how did these other offices replicate what's going on? Right? So it's just something I'm very passionate about because these doctors come to me and often it's not because they're planning to have multiple locations. You know what happens. They have them and they're struggling, and they're telling me, "You know what? These two, we're having to support the other two and I haven't drawn a paycheck in six months." So that's one of the things that I'm really passionate about now is, okay you know how do we get on the rooftops and shout out this message that yes you do need the practice management. But most of you already know you've got it available, right? You go on Dentaltown. You read Howard's books. You read Growing Your Dental Business. But it's creating the environment and having a team of people that's coachable. 

Howard: Yeah. You know so the doctor has one rent, mortgage [00:29:52] inaudible. [0.2] So he decides the best way to deal his overhead is to. ..

Penny: Right. 

Howard: Write mortgage equipment and then he's spending - so he's always spending thirty two hours a week out of a hundred and sixteen, one, that's only nineteen percent of the week. Now he cuts that in half, so now he's down to eight percent in two locations. But the sweet spot today of going bankrupt is between location three and four. 

Penny: Oh yeah. 

Howard: Because when you're right there you can keep that Doberman Pinscher problem. But by the time you get to three, that Doberman Pinscher is now a Tyrannosaurus Rex and it takes you out. And the expanding I think has more to do with ego, because I'll go into dental schools and I'll say - I mean I've heard this several times. I'll say, "Well what is your goal in dentistry?" "I'd like to own four offices." It's like, where does four even come from? I mean, what is - if you - it's not even a number. Like if you.. 

Penny: Right. 

Howard: Like if an office - the average office does seven fifty why don't you say, "I want one office that does three million?" I mean where the hell did that come from? 

Penny: What does the other location mean, right. Right. 

Howard: And it was funny because the McDonald's brothers, Richard McDonald - and you know they were trying to franchise. A lot of the people that watched the movie, The Founder thought, "Well he was a bad guy because he stole the idea from McDonald's. If Ray Kroc didn't do what he did, you would have never heard of McDonald's. 

Penny: Right. 

Howard: And so they can't execute. Everybody thinks it's the idea. You know I mean look at McDonald's. It's on the corner. They sell a hamburger, fry, and a Coke. They have a drive through. 

Penny: Right. 

Howard: You know, duh. I mean do you walk in there and need a Ouija board and you know to figure out what they're doing? 

Penny: No. 

Howard: You just would never be able to execute like that. And so the dentist can't execute on a cleaning, exam, a filling, a crown. I mean you know I always talk about the funnel. I mean look at it. I just saw some real interesting data. Only five percent of the people that land on a dentist's website convert and call. So twenty people have to land on your website to call. The dentist doesn't know that number. He's learning sleep apnea. 

Penny: Right. 

Howard: And bone grafting. So five percent, twenty people are playing on the website for five percent, one out of twenty, to call. Three people have to call your front desk before your piece of furniture can schedule one to come in. 

Penny: Right. 

Howard: And you don't track that. And you don't record the calls. And you don't execute on that. You go in to McDonald's, that sixteen year old has a uniform, a name tag, a hat, and before she could work one hour at McDonald's, she had to go home and do online video training and pass a test, and some of those don't even get through that. Same as Subway. But the front desk furniture piece - no training. 

Penny: Oh absolutely. 

Howard: So twenty go in on the website for one to call, three to call before one to come in, and then three people have to come in with a cavity before one gets treatment. So for the country it's thirty eight percent. We're talking about decay. 

Penny: Yeah. 

Howard: We're not talking about veneers and bleaching and bonding and all that stuff. And then that is what it takes to have the average dental office doing seven fifty, taking home one seventy four, which has been going down every single year. 

Penny: Absolutely. 

Howard: 2005 it was 211,000. And it's gone down about thirty eight hundred a year for a decade to one seventy four, and then all that funnel goes into a bucket which is leaking. 

Penny: Right. 

Howard: So by the time you get to 5,000 charts, 4,000 of them are gone and you walk in there and you say, "Doctor, how many patients?" You know my definition of a active patient is who's scheduled for a damn patient. And I'll say, "How many people active patients scheduled for something a clean, exam, an x-ray?" So that leaky bucket - the hygienist saw eight people today and she only scheduled six for a recall. She just lost twenty percent of your practice yesterday, and you're off to Jamaica to learn how to place an implant. 

Penny: Right. 

Howard: When I could get the periodontist in Tusc - I could get every periodontist and oral surgeon in Tucson to come up to Phoenix and place my damn implants. 

Penny: Right. 

Howard: You just lost twenty percent of your hygiene practice with Amy Lou yesterday. And so they just - so they wonder why corporate dentistry is kicking their ass. 

Penny: Well and we talked about this a little bit in my talk yesterday I said, "Most of your competition is not outside of your four walls. It's in your office. Right? If every day you competed with yourself to do your best, right, to answer the phone to the best of your ability, to engage the patient, to talk to them about what they need." And boy I mean I could talk all day about this part. We think that the inter-oral camera - I mean my clients they look at me it's kind of like, "Oh here mom goes again on a rant about it whatever." Every office has them and they don't use them. And this is where -when I talk about cases acceptance, and I have a funnel that I use in my programs because it's like, okay, marketing dollars, telephone rings, appointment's scheduled, get the patient in, do the comprehensive evaluation. Right? You know we're doing the whole song and dance and then you know we get them on the schedule and then the drip comes out the bottom which is actually the work that we get done, right? So when we have them in there, also when we have them on the phone, but especially when we have them in there, our case presentation needs to be more like Disney. Again, you can tell I'm just a big kid. Right? I'm always going to be a big kid. More like Disney, less like the Internal Revenue Service. I want you to think about that. Disney's known for engagement, right? The whole involving you in the experience. They're not just telling you a story, you're part of the story, they're showing you the story. So the case presentation is everything from - you know when you come in, let's say you're not a new patient. Right? We might take the photos on the new patients or, "Well we take a picture if there's something broken, right, or there's something wrong." Well why not involve that patient, give them more of a why, give them more value. When they sit in the chair, they need to be looking at what's going on in their mouths. We don't need to be telling them about it. And we're starting to play a game now in my offices when I'm there. It's like, "Okay here's the game it's like Simon Says. I'm going to be walking around and watching. You can't talk to a patient about a tooth unless they're looking at a picture and I don't mean an X-ray." I'm here to tell you, I still look x-rays Howard, and half the time I'm like - I mean I'm not a dental trained. I've never been an assistant, I've never been a Hygienist. So I see things very much from the patient's perspective, so when we're talking about the treatment we point to it. When that patient comes back and they're seated in the chair and there's topical on, there should be a picture on that screen where we say, "Hey Howard, here's the tooth that we're working on today." And you know what I hear happened? There's patients in the chair. You know even there was a little old lady I heard in an office a week or so ago, and she looked up there she goes, "Oh I hope that's the tooth we're working on today." And they're like, "Yes ma'am it is." Right? So how much more value does she have for what she's having done, because she was re-engaged with that when she got there. What's next? That picture better be up before they leave the operatory. And if I were to work in the dental office I would never want to make a financial arrangement or have a financial discussion without the photos. But what do most offices do? We're so in love with our digital x-rays, right? And so the patients looking at it, they don't want to look stupid. So they're looking at you, you might as we'll be speaking a language that they don't understand and they're nodding that they understand. Then we go over this treatment plan that has all these procedure codes, which to them - remember the old yee-haw BR549? Or you know you could think IRS form you know, 1040EZ. They're overwhelmed and they're confused. So when people buy, they need to be in a feel good mode. Not in a, "I have no idea what I'm looking," at or as I like to joke, when you say the term profile prophylaxis, most people think you're talking about something that you can buy on an aisle Walgreen's. They're not thinking about getting their teeth cleaned. 

Howard: Yeah, yeah, and then they get their insurance by Trojan. 

Penny: Right, right. 

Howard: Nice name. 

Penny: Yeah. 

Howard: Yeah, we're going to call Trojan and check on your prophylaxis. 

Penny: Yeah. But it's the whole - we keep doing the same thing over and over again, right? To quote Einstein. And so if we really - you know when the doctor comes in the room the pictures need to be up. They shouldn't have to ask. It should be something that happens automatically. But what they tell me is, "Oh we do that." And so I'm like, "Okay great." So the next day we go back and look and we pull up every patient and I'm like, "How many patients did we take inter-oral photos of? Mark that on the schedule. If you know you showed that patient a picture mark, that on the schedule. If you sent the patient home with the pictures, and I don't mean on photo paper. Right? Just print them in color on paper. Check a box." We are watching people - we're just herding them in and out and then thinking, "Okay, if I want to make more money I've got the answers outside my office." No, it's really not. It's in there and we're so distracted by everything else that's going on we're not paying attention. But you can't get people to do those things if they're not coachable. And that's where it all comes down to it's like, Okay." And I watch doctors. "Well you know I've told Suzy seventeen times this is how I want it done." I'm like, "Okay well have you asked Susie?" and I know this may sound dumb. "So Susie let's take a look at this. We've had this conversation, let's take a couple of steps back. Are you willing to do with that way?" "No." "Are you -" I mean why not ask the question, C because if all you're getting is resistance there's something behind that. What it really comes down to is I don't care if Susie is a millennial or you know of a baby boomer whatever age she is, right? Take people out of that box where we've said, "Oh well, she's going to do this because she's in that box." Just ask her if she's willing to do it and if she says she is, just say, "Okay, let's go over this expectation. Tell me how you understand it. And then what is it going to take to make it change?" If not, you're babysitting and firefighting her. And that's all we do, right? We come in every day and we run, run, run, and we're babysitting and micromanaging when the true issue is, Susie may be capable but is she coachable? And I don't care how capable you are, if you are not coachable, you're not going to get results. So can you tell I get all fired up about that? 

Howard: I love your passion. I mean you say so many profound things. You know when you talk about [00:40:33] inaudible [0.7] you know if a pilot if - the United States airlines was successful at 99.9 percent of the time, we'd have four plane wrecks a day. They have to be 99.9999. 

Penny: Wow. 

Howard: They need four .9s. You can't get - I mean and this doctor can't get his hygienist to reschedule twenty five percent? Those pilots - that means one fourth of all the planes of Southwest Airlines would crash every day if it was ran by a dentist. And they don't have a system. I mean just everything. Like to Southwest Airlines. Every plane is a 737. You go into a dental office and the dentist says, "Oh you have a cavity here. God it'll only take five minutes to fill. Let's do it right now." "Oh well, we can't because every room's different." At Southwest Airlines every plane is a 737. But here, "We're going to have to move the patient because this is my room." 

Penny: Right. 

Howard: "And we're going to have to move into another room." Well dude, logistics, execution. You want to learn bone grafting? Why is this operatory not capable to do an occlusal composite? And why can't the hygienist go start in another room? 

Penny: Absolutely. 

Howard: And then they say, "Well we don't have enough rooms." Well so you have enough money to buy a CAD/CAM and WaterLase laser and fly to the Dominican Republic with Aaron Guard. And you don't have an operatory? 

Penny: Yeah. 

Howard: You don't have another room? 

Penny: Doesn't make it any sense. 

Howard: Yeah. And that's why I always tell them - and I'm not just promoting you since you're here but I've always told them the number one investment is not a laser, a CAD/CAM. It's an in office consultant to get your house in order. Get poised for growth. 

Penny: Absolutely. 

Howard: Fix your prototype. And then boys have toys. You might want to have a Ferrari, a laser, a girlfriend, I mean whatever floats your boat. But it's your damn house in order. And that intraoral camera. I mean when I bought my first intraoral camera, it was from Patterson. So it was $38,000 for that Fuji Cam. It was Fuji Cam. 

Penny: Did it look like R2-D2? 

Howard: Yup. 

Penny: Like the little box on the car. 

Howard: It was a refrigerator. 

Penny: Yeah. Okay. 

Howard: But you know what? Everybody was waiting for the price to come down. And 100 percent of my homies that bought it here in all of Tuki and Phoenix, not one single one regretted it because by the time everyone waited for the price to come down to 10,000 five years later we'd already sold another million dollars of dentistry. 

Penny: Right. 

Howard: You know so they threw away a million dollars waiting for the price to come down. And now - I paid $30,000 for the first one. What's That DigiDoc cost? 

Penny: I'm not sure about DigiDoc. I know that's a lower cost. There's another company that I bumped into at Chicago midwinter called MouthWatch. So like mouthwash. 

Howard: Yeah. 

Penny: But MouthWatch. 

Howard: Nice. 

Penny: And I think there's are like literally 295 bucks apiece. They're a tele-dentistry company. They're - have support for a year. And here's the funny part. Are they as nice as the $10,000 dollar camera? Well no. Right? But they get the job done. So I've even had offices saying, not even with that camera, but about one that they got from Amazon. They're like, "Yeah it's ok, but the picture is a little bit blurry." That's the same picture that that patient looked at, one of those same pictures and said, "Are we fixing that tooth today?" So we're not doing this for us. We're doing it for the patient because we've got to inspire in them, create in them an eager want for what we have to do. So often I hear patients only want what their insurance is going to pay. Right? Maybe a fraction of them want that, right? But we're not working on helping them have a "want to." A few years back, I guess maybe I thought I didn't have enough dental business to do for a while, I thought I'd want to be a Dale Carnegie trainer and that's one of the best books out there, right? How to Win Friends and Influence People. So I went through that whole training process and became certified to do that. And really I mean he was like the godfather of motivation and leadership. And one of his principles is to create in the other person an eager want. So when we think about leadership, right, it's like, "I want to learn to be a better leader so that people will do what I freaking tell them to do," right? Isn't that what a lot of people think, right? It's not that I need to change me. I need to change them. But when you get on the path of leadership if somebody doesn't want something we haven't awakened that urge in him. What better to do that than the camera and to ask them what it is that they want. So if in offices when - you know, going back to that culture and the beliefs, I've watched this happen with clients of mine and I call it a tale of two practices, right, instead of a Tale of Two Cities. Similar demographics, similar training, oral conscious sedation training, implant training, similar income levels. There's not that much different in their areas, right? And yet one is kicking it doing the conscious sedation, implants, marketing that, they're just busier in general. Right? Just blowing the doors off. The other one, also certified to do the conscious sedation, implants, they hardly do any of it. Right? This one client says, "We can't - you know we're so busy, like we haven't had growth like this in years." This other office says, "People in our area don't want that. They don't want implants. They don't want the conscious sedation." Well the procedures that I'm talking about, that's just an example. What it comes back to is the whole belief system. If we believe that patients deserve the best that dentistry has to offer, if we believe that we want them to leave with that next appointment, even the whole - and again I'm not a dentist, I'm not trying to step on anybody's toes, but why don't we schedule that? "Oh yeah that can wait until you come in for your next cleaning." What all can happen to distract that patient from coming in for that next cleaning? Like they may even forget they have that small single surface restoration, right? So now they're a few months late getting in for that cleaning, and what was a small restoration, now needs a root canal. So I'm not trying to say that we scare people, but we're just so, "Eh." Everything's important for them right? We've got to watch out, not only for the minimizing language, but using that camera ought to be up there in the priority list. And my opinion right beneath being sure that the instruments in the room is sterilized. Like it's got to go from being something that we'll do if we have time to, this is a must do. And it's a must do because we believe that our patients deserve to see what's going on in their mouth or they can't make the best choices. 

Howard: Yeah. You know I can go into - it's always self-limiting beliefs. Like right now a quarter of Americans, they believe that the fluoridation in the water's toxic. You're not going to change their mind. A quarter of Americans believe that vaccines are toxic. It's like - or climate change. I mean who cares. I mean this is 2017 go back a hundred years. Seventeen of the first hundred years of 1900, 1917 when the flu season came out, the Spanish Influenza, 5 percent of America died. So if you don't want a flu shot, I don't even give a shit. 

Penny: Yeah. 

Howard: But it's all self-limiting beliefs. Like every - I can go into every zip code of the hundred and forty seven largest metros in America, where half of America lives. And the other half lives in 19,008 towns and I can go into any one of those zip codes in urban America and he'll tell me, "Well they - my patients only want what the..." 

Penny: Insurance. 

Howard: "Insurance pays." And then I can do two double checks. I can have CareCredit come in, because CareCredit isn't looking for any new patients because every dentist has tried them at least once and they'll go out there and they'll say, "Okay in your zip code, here's how much - here's every single office that uses CareCredit, and here's how much they finance." And you're financing $387 a year, last month, and the median was $4,000 and then here's this guy over here that's near a hundred. I means - and what's that near a hundred. It's so important because 80 percent of Americans in their lifetime at one time or another will by the average new car. And the average new cars, probably a Ford Escort, Ford Taurus, thirty grand. Yet 95 percent of all dentists have never done a $30,000 treatment plan one time in their life because patients will only buy what the insurance will cover. 

Penny: Right. 

Howard: So say - so you did $387 last month. The median in your zip code was like five to ten grand. And here's a guy over here who did a hundred, because once a week he does a full mouth rehab. And he just wants - they never want to look at the man in the mirror and say, "Damn I suck at selling." 

Penny: Right. 

Howard: "I can't present treatment." And those self-limiting beliefs. They'll sit there and tell the patient, "Well you know why don't we do the two fillings on this side. And then two weeks later come back and we'll do the two fillings on this side, and then two more weeks we'll do -" and then right next door to him is the oral surgeon where his entire life, he numbs up all four quads and takes all four out at the same time. 

Penny: Right. 

Howard: "Well I can't, I don't want to numb both sides of the mouth because you might bite your tongue." Okay. One stupid thought. 

Penny: Right. 

Howard: One stupid thought for forty years. I mean is your - you and I are busy. Would you want to go to the dentist four times for four fillings? 

Penny: Oh heavens no. No 

Howard: Or go in there and just get her done. 

Penny: Oh yeah. I want them all done 

Howard: And back to that [00:50:24] inaudible [0.3] you know they'll say, "Well I need to go learn how to do a oral conscious sedation." Yeah you wouldn't want to just have a board certified M.D. anesthesiologist... 

Penny: Right. 

Howard: Come in your office and knockout. They - every time their house is not in order, they're like a chef... 

Penny: Right. 

Howard: That needs a new recipe. 

Penny: Right. Right. We think we need to add something else to the menu. 

Howard: Oh, no, my restaurant is going bankrupt. 

Penny: Yeah. 

Howard: I need to learn how to make lasagna. No no no no. Enchiladas. No no no no. Fettuccini. No. You know, they're just no chasing all this crazy stuff. 

Penny: Yeah. You need to learn how to make your customers feel like, when they come to your office, they get treated better than they get treated in anywhere else, you know when they come to your restaurant even... 

Howard: Even that they called the new patient experience, because the new patient is the heroin addiction. 

Penny: Oh yeah. 

Howard: The fact that 80 percent don't come back I mean when someone says the new patient experience I'm like, "Dude it should be the patient experience." 

Penny: Every experience. 

Howard: It's the patient experience and the fact that you save the new patient. And it's funny when you look at the Fortune 500, no- how could anybody want a new patient? I mean United - has someone not flown United? Is United saying we need new patients? I mean Chase, Amazon... 

Penny: Right. 

Howard: Wal-Mart. 

Penny: It's all about the repeat engagement that every... 

Howard: Yeah do you know anybody who hasn't been to Wal-Mart, Costco, Southwest Airlines, or Chase Bank once? 

Penny: Right. 

Howard: I mean, you're coming up on fifty. I'm coming up on fifty five. Nobody in the professional Fortune 500 wants a new customer. They're all trying to figure out, "Doc you have 5,000 customers. 4,000 have not come back in the last twenty four months but only 687 are actually schedule for anything. And you know - and it's like... 

Penny: What is that telling you? 

Howard: Yeah what does that tell you? 

Penny: So even at - go ahead. 

Howard: But I want to get back to your amazing book ‘Growing Your Dental Business.’ You talk about the five drivers. 

Penny: The five keys to grow your business. 

Howard: Yeah the five keys to drive your - do you want to talk about that? 

Penny: All right so the five keys to growing your dental business are increasing the new patients, right? They are also increasing the active patients, which I love how do you define an active patient. How I define it in the book and what I look for, is I'm looking to see how many different people have been in, you know like how many unique individuals in the last two years. And we measure that every single month... 

Howard: And and. 

Penny: To be sure that it's growing and not shrinking. 

Howard: And in the average dental office, that's what everybody does, and that's a great metric. 

Penny: Yeah. 

Howard: But in average dental office about half of those are actually scheduled for time. 

Penny: Right. 

Howard: So there if about 2,000 have been in the last twenty four months, about a thousand of them are actually scheduled for something. And that is the low hanging fruit. 

Penny: Absolutely. 

Howard: I mean why are you - I mean why would you worry about China, Russia, Istanbul, and Brazil? You've got a thousand people that have seen you in the flesh in the last two years. Why aren't they scheduled for a cleaning? 

Penny: Absolutely. 

Howard: An exam, anything. 

Penny: And I think a lot of that is again because we think that they don't have the money. And the bottom line of it is they don't want to do it bad enough, to spend the money. Right? It comes down to that whole engagement and the "want to." So one of the other keys is to increase, which ties in to active patients, increase the percentage of our practice, if we're pediatric or general, that we're seeing on a regular basis in hygiene. And we've got to get away from the whole, "Come in for your free cleaning," or, "You're due for cleaning," and it's got to be the dot - it takes thirty seconds to let that individual patient know why it's important that you see them twice a year. You know not because the toothpaste company said, or your insurance pays for it. It's you've made a significant investment in your mouth and yeah, you are prone to decay. You are definitely somebody you need to keep those appointments. Instead of, "Oh yeah we need to get you in." Well what's the why behind that. Right? The patient has no idea. So efficiency is another huge piece increasing the efficiency and you were talking earlier about the employee that - the new hire that says, "Oh yes I know Dentrix." Most offices learn enough about the practice management software to survive. Right? It's like, "What do we need to do just to get through the day." There is no continuous, constant and never ending improvement. How can we get more efficient with this, more efficient with the charting, save some steps here. We're always looking at the schedule, the schedule. Well You know what? The slower than everybody is, the longer it takes to process a patient from the time they call or walk in the door until they go. So the efficiency piece and then last, the fifth key is is the case acceptance. And one of the tools - measuring case acceptance, my husband's in sales and we talk about this all the time. You can doctor up the numbers enough on case acceptance that you don't even really know what the percentage is, right? But you still need to look at it and track it. So in an office if you're presenting an extraction, if you're presenting that same extraction with a bridge, or that same extraction with an implant and a crown, and the patient accepts the extraction. On one hand I presented a $200 treatment and $200 was accepted. Right? So it looks like my case acceptance is 100 percent. Well is it really? Right? So I mean it's like we can look at that and go, "Oh, well our case acceptance is awesome." Yeah it's awesome at presenting the bare minimum of what anybody would want. Right? So there's that part of it to where we'll never - you know no matter how you slice it there's always going to be a different way to look at it. But along the lines of what you're talking about, what I'm starting to have clients work on - because this is one of these problems that just drives me bananas that I want to find a better way to measure, is I'm having my offices look at on their reports, "What did we treatment plan today?" Like so for today everything that was treatment planned. And then run another report for the next ninety days. Because here's my thought process. If they haven't it scheduled for the next ninety days, what's the reality that they're going to ever schedule? Now I don't know that there's a stat on that but I imagine that within ninety days it's just a downhill slope. So they're coming up with what's the total that was treatment planned, and then they've got that other number that shows what we worked in today and what was treatment planned. And they're measuring that every day. Right? So it's showing them, "This is how much we treatment planned, and then this is what we scheduled." So everything else walked out the door and didn't have a phase or something that went with it to create that awareness because we don't know. Right? We're looking at the numbers and we're thinking the answer is, "I'm going to go to this course." Which CE courses are great. Right? Or, "I'm going to go get certified to do this, that or the other," when they actually have all the resources. This is a thought that comes to my mind. If you had a mouse in your studio, right, which you don't - I saw like a gecko or something outside. But if you had a mouse in your house do you need a digital remote mouse trap? I mean yes people are always talking about building a better mousetrap. What does it take to kill that mouse? A 99 cent or $2 mouse trap from Safeway. Right? So we keep thinking that, "Well if we've got this other, that's going to solve the problem," and I love how you talk about it. You get your basics in order and then once you do - going back to the culture piece. The biggest mistake that I see offices make, is like they don’t take any time for training. Not even going to CE, right, to enhance their skills. But they come back to the office and when they’re not seeing patients they might have one short team meeting every other week or a month, but there is no practicing that takes place. So I'll give you an example of something that I learned from the Dale Carnegie organization that was super powerful. Is - this is a twelve week program. You bring people in from all walks of life. McDonald's shift supervisors, CEOs, executives from FedEx, all walks of life. We teach them something and then immediately they practice it. Immediately they practice it. Or in the office we say, "Oh we're going to role-play. And then right? Everybody wants to pass out or they suddenly need to go to the bathroom or clean the bathroom. Right? Nobody wants to practice that. So there's two parts to that. One is we say practice makes perfect, right? But here's what I want you to think about. If you don't intentionally practice something while you, the doctor, right? If you've got the expectation of how you want it to happen it's like, "Well I don't want to have them practice that. It makes me uncomfortable." So guess what. Every day they're practicing that in real time with your patients and they're creating permanent habits. So practice doesn't necessarily make perfect, practice makes permanent. So if you don't invest, again this is the whole culture piece, that time with your team - but again I hear from the dental business owners, "I don't have time." Right? "I've got to be chair side. I've got to be doing this, I've got to be doing that." Heaven forbid, right? And want my doctors to have time off, right? I mean you and I, when I interviewed you for my podcast we talked about what's the secret to not being burned out. Right? And you're talking about got to have life balance, right? You know, the yoga, and the things outside of the office. But if we don't make time to train our team, and yes that - some of that means having a consultant come in, but the other part of it is, are we working on that stuff you know, when the consultant isn't there? If not unless you have a Penny Reed or a Howard Farran or fill in the name with - the blank with the name, you will never be able to get it done without someone like us. And I think that's one of my missions is I not only want to teach you what to do, and teach you how to coach, I want it to be where, you know what you guys want to work with me, right? But you don't need to work with me in order to be successful. You've been able to adopt these habits. So the five keys to growing your dental business are hugely important. But if we don't have those drivers of culture, which you know the last was, you've got to coach, and you've got to coach often. And for the doctors, whether you feel like you're a leader or not, you've got to be willing to give people feedback. I don't mean be ugly to them, but if your office manager or your administrator isn't answering the phone the right way, every day that goes by that nobody coaches her on that, what does she think? She thinks she's doing a good job. Right? So if you do sit down as I love you talk about when the earth rotates around the sun every 365 days so we think that we need to give a review, right, or the team members think they need raises. If you don't tell me about my performance but once a year, my thought is I must be doing okay. Right? Because you haven't given me any feedback. We want to hire people at the hiring process, I want to know if you're coachable, and I want you to you know, "Well Howard tell me about that. What do you think makes you coachable? How do you accept feedback?" I want to hear what they think about that and I want to say, "You know what, we've got a great practice. We think you're going to love it here. And all of us from the business owners, to the office manager, to the rest of the team, one of the most important things here is that we are always learning and we're always open to feedback," right? We don't want to deliver feedback in a mean way, but if we're not open to feedback I don't care how smart you are, or what you know, or how many different procedures you can, do your ability to get better, I mean it's - you just cut it off. 

Howard: That was profound. Yeah. I mean so profound. Back to when I am in a office that does a full mouth rehab case a week, the most interesting thing is that is you know they'll take the panel is the best-selling deal. Some are now doing a CBCT but that's just overwhelming it looks like the Hubbell. But they'll just sit there with a CVT and in their walnut brain, they all have the same thing they say in common that you know to get a dollar you've got to diagnose three. So you know they're not in there diagnosing your checkbook thinking, "Penny came up in a 1974 Dodge Dart and she's eighty two years old." You don't know what's going on in her life. For all you know her husband just died and she - and so they'll sit there and say, "Okay so you're missing your back teeth here. So that would be you know we'd put two implants, here two implants here, and two bridges here," and they just treatment plant ideal. Every single time. Every time they look at you they just think, "That this would be what's ideal. Okay so you know you need four quadrants, a cleaning. You need this, that." And then you go into the next deal and they're the - and I mean we're talking like 95 percent, they're just like, "Okay well what is the worst tooth?" And their insurance only covers a thousand. So you came in and this one broke off, so we'll just do a crown and we'll max it out and this and that. And that single, single self-limiting belief is just a game changer. And then there's this, you know, this 5 percent, this one in twenty which is about the general dentist conversion rate from the website to call the office and every single patient, chair side, fast, efficient, we'll just tell you everything you need to do. And it's a full mouth treatment plan. And some of my friends that do that say they only - like baseball, you know. I mean they only swing - hit like one out of three, and some are like one out of five. But these guys that are doing in one case a week, they pitched it five times. 

Penny: Absolutely. 

Howard: And they're pulling everything out of their mouth and rebuilding it once a week and just going back to the dental decay, I mean I just don't know how you think you're a good dentist when only - just cavities only 38 percent of the cavities you fix. And you're all happy and you're in the peer [01:04:41] inaudible [0.7] and the Mastership and AGD, and you went to the Pankey Institute and you're a mentor at Kois. Dude, two out of three of your patients. I mean I wish you would have moved - removed the decay. 

Penny: Right. 

Howard: And packed it with butter because that would have been so much better. 

Penny: Or bacon. 

Howard: Yeah bacon. 

Penny: Because bacon. Everybody likes bacon. 

Howard: Everybody loves bacon. My God. Yeah I mean bacon is the greatest thing in the world and only 11 percent of a pig is bacon. 

Penny: You should do an entire podcast on bacon. It would be fun. 

Howard: Oh my god. 

Penny: I'll come back for that. 

Howard: And back to that efficiency. I mean I'm back to the pilot where he's got a 99.9999. They only work from checklists. I mean even if you know, the - you can see the blue skies, you got to check the weather report. Every single thing because they need .999. There's no systems and no one follows them. And you get them on the walk - and then the embezzlement. I mean they don't even have... 

Penny: Oh yeah. 

Howard: Their banking on their phone. They can't even see red flags like, "How come we never deposit cash?" At the end of the day the hygienist cleans up her room and leaves. She doesn't have to go have a pilot's checklist to say, "I saw nine people today and I rescheduled this." 

Penny: Well and don't you think a lot of that goes back to - again it's that whole, "I don't have time." Right? Which you almost have to look at. I have a have two eighteen year old girls. I have an eighteen year old daughter and an eighteen year old stepdaughter. Okay, so when your kids are growing up and they tell you, "I don't feel like doing that," that's what I began to hear now when I hear, "I don't have time." Right? It's okay, so we don't have time, but if we were to make time, how would we do it? So without - I don't have time to make the checklist. Right? So it's the firefighting cycle. Well so let's take ten steps back. If Suzy, or if Howard, if this is the right person in that position and they don't have a clear picture of what it is that we want them to do - and this is everything that's in the picture, right? Here's what a good job looks like. Here's what it looks like when we don't do it right. Right? Here's the consequence to the patient. Here's the consequence in the office. Here's how often we want it done. Right? So if once we paint that clear picture, right when I look at it I have a team member, or a client, or a client's team member that I feel like I've given a clear picture and they're still not getting it done, I go back, right - ultimately accountable, right? I'm the coach, I'm the trainer. Did I show them? Did I give them all aspects of the picture. If they have the picture and it's still not happening, it's not that they didn't have the checklist. It's that they either didn't have the "want to" or they didn't have the "why to." But who couldn't make a checklist? This whole business of, "We don't have time to create a checklist," or I've watched in some of my client offices - and I love all my clients but I get lit up when I go in the ones where we've got really coachable team leaders, right? And they're coming to me and are like, "Okay I want you to watch this. Listen to this and let me tell you this training process for our new team members that come on board," and I watch her go through the whole thing and I'm like, "That's awesome. Why isn't that videoed? Why do you have to, every time you have a new team member come on board, why do you have to go through that whole spiel with them every single time? You ought to have that videoed. You sit down you say, 'Here's what we're going to go over. I want you to watch this. I'll be back in a few minutes. And when I come back I want you to tell me what you learned from that.'" Do you see what I'm saying? It's like even - they're so busy. And then the other is if they're clinical, when I go in an office I love it when they have the walkie-talkies, right? I'm like, "Give me one," because I'm going to hear what's going on. And this happened just a couple of weeks ago. So I go in this office that is an office that just went from nine operatories to eighteen. Right? So just imagine what happened with the overhead in that office. So the pressure is high to produce. And this team leader, she's the clinical director and the office manager. I mean I just look at her, by like nine o'clock that morning, she looks like she's been there all day. Right? Somebody says, "I need perio charting in room 2." She's like, "I'll be there." You know, "Hey Susie we need you in room 4. We need you upstairs we have a question." So what I watched her do all day was run around like a glorified extra person. And so I just said, "Here's why you're stressed." And then I talked to the doctors. "Here's why she's not - she doesn't have a handle on the numbers and she's not able to talk to these different people about things. It's because every time somebody calls over there for something, she's trying to set this great example and she's running and doing it." I said, "Her role is to be sure that everybody else is doing that." You know it's like, "In room 4 we need perio charting." I said, "You listen." Hear, is anybody else answering? If they don't, your role is to repeat, "Can someone help Glynda in room 4 for perio charting?" I said, "If they're not available, then you go." I said, "Less than 10 percent of the time. Should you be the one that's running in there you will never be an effective leader." And so one of the things that I'm doing now that I had not done previously, with these larger offices we have more team leaders, is I'm actually holding sessions for the leadership and the dentist to talk about the culture and to learn how to coach. You know a true coach and true empowerment is if somebody works for you and they're capable, your job is to help them do whatever that is for themselves, right? It's not to give them the fish. It's to teach them to fish, and you will never grow beyond whatever it is that you're doing right now if you can't do that. You're always going to have a team of people that are just sitting there and they're saying, "Oh well I would have done that if you'd have just asked me to." Right? Has parenting not been one of the best teachers that you've had as far as managing people? So I had an epiphany. I've asked my daughter, I was like, "Did you unload the dishwasher today?" Like every day her job is to load or unload the dishwasher. "Oh well you didn't ask me to." All right, so after I had my meltdown, Right? Like the like the bad witch in the Wizard of Oz. I said, "Okay, let's take two steps back. Every day this is no different, right? Every day that's your role." It hit me. She only felt responsible when I made the direct order. Right? But she wasn't accountable. And so again what I see happen is one of the biggest challenges in dentistry is the turnover. I mean you talked about it. Right? So if we don't have that culture in place that sets the expectations, gives the appropriate training, gives feedback often, right? If we wait until people were in trouble to start talking to them, you may as well - you can just - you don't necessarily need a revolving door, you can just put a doorstop in the door and leave it open. And then you're going to bring in these other people, who most of the time I would say a lot of the hires made, if you're hiring for personality and not for the dental experience. Oh don't even get me started on that. Most people that have dental experience, they're not the best employees out there. It's better, like what you talked about, to take that - if they've got the ability to think, and the coachability. But you can even put a great person - if you put a great person in a toxic environment, are they going to want to stay there? No. They're picking up the phone and calling me and going, "I'm not really sure I got myself into." Right? And I'm like, "Well you know, they don't want to lose you. We don't want to lose you." We need to work on that. 

Howard: Yeah I see some many offices where they have this massive, massive, massive turnover and they get this one wicked witch in the office and it's like - and it's always doctors favorite. And you know... 

Penny: Of course. 

Howard: Because she's Jekyll and Hyde, she brings him a Starbucks and a muffin and, "La-la-la." 

Penny: Right, yeah. 

Howard: And then she's a witch all day while he's doing a root canal. But you know we just started the NFL season and you know the couple - they started four preseason games and each team had about seventy five players and they had to trim it down to fifty. And you look at these thirty eight coaches and I mean if you didn't catch the ball four times - how many times would you have to not catch the ball before they'd fire you and cut you. 

Penny: Oh. 

Howard: I mean - and you know you'll go into an office, you'll say, "Okay I want every one of these operatories a 737. If I go into any operatory I'd open up drawer 3, it's the same in every room. And no one owns a room and if I go in here and the hygienist, 'This guy needs a filling I want do it.'" You've got to have extra rooms because rooms earn your costs. And then you come back like a week later, a month later, six months later, and they still haven't done it, because Doc - they know that you just let him vent. 

Penny: Right. 

Howard: He went to a course, he listened to a podcast. Let him vent and he accepts mediocrity. 

Penny: And he thinks it'll never change. 

Howard: And he's a town of 5,000. And I'm like, every one of those towns of 5,000 has got a dozen small businesses that do three million a year. The owner net's a million and they found all them people in that small town. There's people that love - they're workaholics. 

Penny: Oh yeah. 

Howard: They just love this shit. And you know I call it the 80/20 rule. You know about 20 percent of my employees are probably workaholics. And you can't find that out in the interview. 

Penny: Right. 

Howard: But what you can do is -you know you can't interview and process and find your A players. What you do is you get rid - and weeding out the Fs and the Ds is no brainer, but what these guys can't do, is they can't get rid of the Cs because if you keep getting rid of the Cs - because how that culture works is the founder is in charge. The head rots - the fish rots from the head down. The founder starts the culture, and then you know some people come and go and come and go and come and then someone likes that culture. And then they stay. And then people come and go and come and go and then someone comes and they like that culture. And then eventually the founder can die. Like Sam Wong died. Ray Kroc of McDonald's died. I could die. But my Lori, my Karen, my Stacey, my people have been there - Tom, Jill - these people have been there decades. They agree with the culture. And so the new people coming and going, they come and go, "Oh I don't like this culture," leave. You know so - and part of the culture is you know you've got to be humble, you've got to hustle, you've got to be coachable, you've got to have fun, you don't make people - I have my 12 Deals. "Ryan will you go grab my 12 Deals? You know where it is." I went into that because man we went sixteen minutes over. My gosh we got talking. 

Penny: We did. 

Howard: Like a couple of school girls... 

Penny: We did. 

Howard: On the park bench. 

Penny: It was fun. 

Howard: But here’s our culture. Our culture, which we've had for thirty years. You're going to - I'm to get to twelve, you know there's twelve and they say the Twelve Apostles, and the twelve zodiac, and you know twelve is a big numbers so I started to create a fun, positive, and professional environment. Be passionate, enthusiastic, and determined to make a difference. Be humble. Embrace and drive innovation. Follow the golden rule. Treat others like you would want to be treated. Mistakes will be made. Be accepting and  accountable and move forward. Never stop learning. Be honest and respectful. Integrity is everything. Balance - life and work can be fully present in both. Strive to make everyone feel safe, valued, important. Be remarkably helpful. Create opportunities to make our customers and patients feel special. So what I do - everybody has these core values. So sometimes you know I'll actually pull it out and I'll sit there and say, "You know," well like balance life and work. Like the dentist in between phone calls, in between patients, sending someone out, and then he'll go call his wife or check on his kid. But then he'll tell his staff they can't take personal phone calls. 

Penny: Right. 

Howard: So she - the assistant can't even focus because she's wondering if her kid ever got dropped off at school, and you know it's good for the goose, good for the gander, so I like have balanced life and fully present in both. Strive to make everyone feel safe. Well the whole news is talking about bullying, and every dental office [01:17:23] inaudible, [0.9] there's this one person, it's the office manager, it's someone, and usually it's a legacy employee. 

Penny: Right. 

Howard: And she's driving all the turnover, all the stress and all the misery. 

Penny: Yeah, and even the doctors are afraid of her. 

Howard: Yeah. And be remarkably helpful. I mean I don't care that those aren't your instruments. You know, if it's someone else's, well be helpful. Clean her damn instruments. Humble is huge. 

Penny: Absolutely. 

Howard: I hustle. I mean I remember when I used to open and when I was slow, and we'd have a cancellation and I'd always have a stack of flyers and I would tell the assistant - I mean it'd be in Phoenix, Arizona 118 and I'd say, "Hey go stick one of these under every windshield in the parking lot and it'd be 118 degrees. And I remember one time one came back and I said, "Did you do it? Did you go?" "No." I go, "Well what do you mean no?" I said, "What do you mean?" She goes, "Howard you did that two weeks ago and you did it four weeks ago." There was an apartment complex a mile down the street, and I thought I'd go nail the apartment complex. You know just hustling. 

Penny: Yeah. 

Howard: Hustle, humble, hustle. Integrity is everything, but man we went way over. 

Penny: Yeah we did. But no, I love these I love these actually have something similar to that, that's a free download in an upcoming article. But it's already up. So if your listeners, viewers want to go www.attitudeupgrade.com, it's a list of what I call the B Attitudes, right? Sounds like I'm playing off of the Bible. 

Howard: So that's not - your website is growingyourdentalbusiness.com. 

Penny: Correct. Correct. But that little pre-download is at attitudeupgrade.com. It's a neat little poster, right? If they want to adopt those they can. You know they can just print it off and hang on their wall, but it talks about being coachable. You know it talks about how we're going to interact with other people, and it's similar - a similar vein to yours but I love those. And you've got to revisit them, right? You can't just type those up and put them in a book somewhere. 

Howard: Right. 

Penny: That needs to be gone over in your interview process, in team meetings. We need to do a self-check. "Hey guys how are we doing?" You know and you the founder, "How am I doing with the being humble," right? You know I mean one of the true hallmarks of a great leader is that if you were, let's say doing something that wasn't out of humility, that it would be okay if a team member came to you, maybe didn't call you out, right, on a podcast or in front of everybody and says, "Hey Howard can I talk to you about blank?" Right? "When this happened, you know it kind of came across this way and you know what you may not care but it just it didn't necessarily seem to mesh with that." 

Howard: Thank you for... 

Penny: This has been so fun. 

Howard: All that you do for dentistry. 

Penny: Yeah, we went way overtime. 

Howard: Yeah we went way, way over time. Thank you so much. 

Penny: Thank you so much Howard. 

Howard: All right.