Dentistry Uncensored with Howard Farran

How to perform dentistry faster, easier, higher in quality and lower in cost. Subscribe to the podcast: https://podcasts.apple.com/us/podcast/dentistry-uncensored-with-howard-farran/id916907356

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Dr. Palmer is a member of the American Dental Association, Texas Dental Association, East Texas Dental Society, the American Orthodontic Society, Mid-America Orthodontic Society, American Endodontic Society, the American Association of Functional Orthodontics and American Academy of Cosmetic Dentistry. A child of missionary parents, Dr. Palmer grew up in different locations in West Africa before returning to the US to become a dentist. He completed his undergraduate studies at Houston Baptist University and went on to earn his dental degree from the University of Texas - Houston Branch. Dr. Palmer has advanced training in cosmetic dentistry and orthodontics, allowing him to offer accelerated orthodontic care to both adults and children. Dr. Palmer continues the tradition of community service by active participation in youth athletics, both as a coach and league president. He also has taught Junior Achievement in both Lufkin and Huntington. Dr. Palmer and his wife, Debra, have two children, Hunter and Halee. Dr. Palmer is a licensed ship captain and has operated a charter fishing boat company. The doctor is not responsible for longer appointments caused by discussion of offshore fishing and hunting.

www.palmerdental.com

David: Yeah. I wanted to say it before we got going too far, Howard that you are a huge – been a huge inspiration to me and to my practice. And I think partly it was because this long before Dentaltown but partly because of your 30-day MBA, going to watch you, son, and I noticed you are about my same age and I said this guy is moving, he's on fire and it caused me to get up off my butt and get going. And I really appreciate that. So that 30-day MBA got me going. I actually set it up for my staff to watch. They thought it was hilarious. Most of it too. So, anyway I really appreciate it. Even before Dentaltown you are a big inspiration me. It changed my whole practice. And then Dentaltown came around and, good grief, what a resource.

Howard: Well, and what's amazing is as I did that 30-day MBA what I did is – did I ever tell you the story how I made that?

David: No, no. I didn't know.

Howard: So my dad taught me all the business I know and he had nine Sonic drive ins. He had five in Wichita, one in Abilene Kansas, Kearney Nebraska, Childress Texas, Louisville Kentucky. But I always wondered about 10 years out of school, I said, was my old man's spot on me – I mean I knew my dental assistant could do a crown and filling but shouldn't have the dental license that I am going to go back and get my MBA. So I went to ASU. There was Mondays and Wednesdays from six to ten. It was two classes, two hours each long. It was a trimester so it's two courses a trimester. So six courses in a year, 12 in two years. I got my MBA.

And when I was in that MBA I sat there and I bought my first laptop to be taking notes and all. And I took that notes as applying to a dental office and then I was implementing it all the way through. All the class projects I did on my dental office like everyone else is picking these sexy companies like Cisco and Dell and Intel and Microsoft. And I was always picking my Today's Dental office and it was tough because when we got to a group project. They go, I don't want to do a dental office. So  I was older than them, so I said okay, well, I'll buy all the beer, all the pizza, all bribe you or whatever. But so I took notes and when I was done I thought how – I'm just going to read my notes. And it took 30 hours to read all those notes.

And that's why it was a 30 hour long, 30 day dental MBA. But you paid good money for that back then and thank you so much for that. But over the years I just put it on YouTube in the video format and iTunes for the sound and it's being downloaded like 4500 times a month and I get a lot of emails about how great it was and I replied I can say well that's 20 year old information.

They say well, if you learned Calculus 20 years ago what's different saying Calculus and Physics and Geometry today than 20 years ago? But they still love it. So many guys are listening to this on iTunes. Switch over and subscribe to – what's that and how do they get to it? It's called – just type in ‘30 day dental MBA’ . But our guest today is David. What's the T stand for you said?

David: Terry. Terry.

Howard: David Terry Palmer, DDS. He's a member of the American Dental Association, Texas Dental Association, East Texas Dental Society, the American Orthodontics Society, Mid-America Orthodontics society, American Endodontic Society, the American Association of Functional Orthodontics and American Academy of Cosmetic Dentistry. A child of missionary parents Dr. Palmer grew up in different locations in West Africa before returning to the US to become a dentist. He completed his undergraduate studies at Houston Baptist University and went on to earn his dental degree from the University of Texas, Houston branch. Dr. Palmer has advanced training in cosmetic dentistry and Orthodontics allowing him to offer accelerated orthodontic care to both adults and children.

Dr. Palmer continues the tradition of community service by active participation in youth athletics both as a coach and league president. He also has taught Junior Achievement in both Lufkin and Huntington Texas. Dr. Palmer and his wife Deborah have two children Hunter and Haley. Dr. Palmer is a licensed ship captain and has operated a charter fishing boat company and he says on his website it's so funny ‘the doctor is not responsible for longer appointments caused by discussion of offshore fishing and hunting.’ That is so cool. How is your boat doing after the hurricane? Because you're down – how far you from Houston?

David: Okay. Well, we used to fish out at Sabine Pass close to Houston but I sold my boat, now, a few years ago and I generally fish on other people's boats now. But I have a long little time in there where I was the captain and took people out charter fishing for probably 10 or 15 years in the gulf. So I've pretty much given that up. I tend to go on other people's boats now but I haven't given up the fishing.

Howard: That's the old joke. Why would you buy a boat. You just need a friend with a boat. Let your friend buy a boat. All you need to do is get a case of beer and some hamburgers and show up on his boat. And I want to ask you  a question about that hurricane.  if you go back 100 years Galveston got wiped out and the forefathers of that town said we need to move inland. And the forefathers of Galveston after a wiped out hurricane moved all the way up to Houston. You think Houston can rebuild on that same spot knowing that it's just a matter of time 10, 20, 30 years and they're going to get the same thing again or – what's your thoughts on or should they all move another hour up the river?

David: I don't really know where else they could go and Houston is just so flat. Houston is about a hundred miles from here. We have some hills and we can withstand that kind of rain but it's just brutal down there. I feel sorry for them. It's actually more devastation than I think that Irma did. It's just that everyone got flooded and it's just terrible to see but I don't think they can move.  It's just going to have – they just have to deal with it.

Howard: I wonder if there will be new technology in civil engineering where they can rebuild better or somehow prevent that because, my gosh, on Dentaltown. There's so many dentists. They lost everything.

David: Oh yeah. I got lots of friends down there too from our class. They just got standing water everywhere and standing water is such a mess. I just feel sorry for them. It's just so much work to tear everything out.

Howard: My God, it's eight pounds a gallon. I mean it's one thing to have a hundred mile an hour wind throwing eight pounds per gallon of water start taking your house. I mean it knocks it off the foundation.  Being a big fan of your 9,321 posts since 2000. I'm only asking you questions for the podcast listeners because I already know all your answers because I've been a big fan of yours for 20 years on the board. Why is it imperative to work on your basic clinical skills and people skills before people before you buy all the cool toys out there?

David: Well, that's one thing I really wanted to stress all these to kind of help out some of the younger dentists in particular because one of my pet peeves on Dentaltown is to see some young dentist who is very much in debt ask, what do I need to get started? And he immediately is hit by  – I think caring people and people that might have bad intentions but they say you need just CEREC and they're you may saying the latest laser, he needs a cone beam, he needs CBCT, all these different toys. And in reality that puts this person trying to get started so much more in debt. I think that is common sense flown out the window and  my recommendation would be, how about we memorize this book, How to Win Friends and Influence People. And then I will follow it of course with the Howard Farran book.

Howard: Thanks buddy, I'm complicated. And  that book, How to Win Friends and Influence People, that was one of the greatest books ever written. I mean we're all in the people business.

David: Sure I'll learn that more from you too. About that, we're all in the people business. It's all about – we're mainly dealing with women and if you cannot get  good rapport with patients you're just going nowhere. I can assure every dentist out there that you can have the best equipment in the world but if you are rude to the patient and hurt them they're going want somewhere else. They're going to some other place, to someone where the staff is nice, the dentist is nice and you don't get hurt. To me that's really common sense but I see a lot of people buying a lot of things that I think are unnecessary for good dentistry. I'm a living example I have none of that. And I've been in practice 30 years. And you don't have to have every latest toy. But if you want them make sure you can afford them. Don't just put everything on a note, in my opinion.

Howard: Yeah. I talked to – I did a podcast with AJ who's acquired, bought 19 different dental offices. Only two of them had chairside milling and both of them are never used.

David: I don't find that surprising. . I know some other people in Dentaltown think that Mr. anti-technology or something but I like technology that you need and works well. I mean you certainly need an intraoral camera to show your patients. But the problem is that you can buy intraoral cameras for 150 bucks now.

Howard: 150 bucks, where the hell are you buying for 150 bucks?

David: Ebay. dare you or something. (inaudible 00:10:05)  type. And they work. They're cheap, little – everything technology-wise keeps going down in price so you can get intraoral cameras  for cheap.

Howard: Do you know  how much I paid for my first intraoral camera? It was the Patterson sold it– there was the Fuji cam. It was $38,500 and even though a lot of my friends waited three or four years till the price came down of other brands like for about 10000. Everyone I know who bought it for thirty thousand didn't regret it because it sold so much dentistry for those 4 years that they would have missed out on 2, 3, $400,000 of dentistry waiting for the price come down. But now you say you get it on eBay for $150?

David: $150. They work great. Well, I  have Eaglesoft but they work great with, I think they come with a little  software thing. It's simple. So there's no reason...

Howard: Do you know the brand name of them?

David: The name or that is called Daryou, D-A-R-Y-O-U or something along that line.

Howard: Wow. And  and  you just like keeping it simple. Like when people always talk about  your Yelp reviews and how important it is to get Yelp reviews and buy all this software to help you get Yelp reviews. Hell, I'd rather bet my money on the dentist that can give a painless shot than the guy who has all the Yelp reviews. I mean there's nothing more amazing than learning how to – I mean if you're not getting one today saying, man I didn't even feel that. You're good doc and fist bump you or something. I mean I'd rather be the guy with a painless shot that went, read How to Win Friends and Influence People and know how to have a good chair side manner and not talk down and not be condescending. Agree or disagree?

David: Now I absolutely agree that that is the one thing people are scared to death of and we deal in a whole profession where people are scared to death. And if you can give a painless shot you got it made. And I preach that on Dentaltown over and over and I'm amazed that some people still don't try it but it's very, very simple. Small 30 gauge needle you warm up prilocaine plain and you inject very, very slowly as your first injection just that prilocaine plain. Then you can follow it slowly with septocaine. I like septocaine of course  or biocaine, whatever you want. But if you do it correctly everything but the palatal can be completely painless and  the patients absolutely like that. Our patients that tense up and they still don't know you've given them the shot and they're just completely thrilled because they've been hurt somewhere else. And don't think they don't go tell everyone because I don't see any patient asking any other question. I don't see the patients' friends asking any other question than, did it hurt? And it better not hurt.

Howard: So, prilocaine that's Citanest, right?

David: Right. Right. But the plain, no Epi in it.

Howard: Okay. And why prilocaine, generic, brand name Citanest  Plain, no Epinephrine. Why that?

David: Well, it's really, really close to body ph, I think it's 6.8. And so I think it's way closer than all of the other brands with Epi in it in particular I think mepivacaine plain might be very close also. But prilocaine plain and it's warmed up a little. We have warmers in every single operatory so we always get a warm prilocaine plain and a 30 gauge needle and it is very difficult you cannot feel it at all if you go slow.

Howard: Okay but the kids in dental school and the young ones are saying well you can use a 38 small you have to use a long, 27 gauge long, right? They did that in dental school. Their instructor is saying you got to use long. What are your thoughts on that?

David: Well, I don't know. Thirty years strong I've used short 30 gauge needles period.

Howard: Same here. But I don't tell anybody because other people say well you can’t aspirate.

David: No. I don't see the problem with that either. I mean the trick, you just go on very slow. I hear people having trouble with septocaine or some other problems. I think they're taking a big needle. They're jamming it very hard and they're pinning that nerve up against the  mandible somewhere and then injecting quickly. That's how you get in trouble. I think going very slowly with a very small needle, you aspirate, go very slow. It's no problem at all. And I had very, very few problems with any type of paresthesia. I use septocaine for almost everything now. It's such a good (inaudible 00:15:02).

Howard: Same here, you and I are twins. I mean – and then the other deal is when you keep saying slowly and what I always say is that  you and the other patient on the chairs both have 99.9999% the same DNA. So the same pressure receptor in your thumb. If I'm feeling in my thumb they're feeling it in the jaw. It's pressure, it's (inaudible 00:15:25) nerves, (inaudible 00:15:27). So when I give that injection I want to try to give that (inaudible 00:15:31) without feeling my thumb pushing on it.

David: Absolutely. And I think many dentists just get in a hurry that they want to go ahead and they take lidocaine plain or lidocaine one to 100 which is taught in dental school, room temperature bigger, needle and inject it quickly. And there's no getting around that's going to hurt or hurt big time.

Howard: And I'll tell you what. They leave your office. I've been there 30 years. They leave your office and they go somewhere else because the insurance or it's closer to work or whatever. And they come back and they tell you for 30 years, oh my God I went to this other guy. I thought he was going to kill me. That's like dude, it's just intro 101 you have to give a painless shot. So you're saying the room temperature in an air conditioned dental office is probably 68 to 72 degrees and the body is 98.6, so where do you get these warmers and how long do you put them in there? How long does it take to warm up to body temp or do you warm them up more than body temp?

David: I don't know. I don't even think it's all the way to body temperature. I don't really know (inaudible 00:16:35). It's just a little square box that you fill so when you press the button it'll pop out the bottom and all there is at the bottom is just a little light bulb to warm them. So we can have one in every room and right before we get the injection we just pop that little, tat, just press it. Out comes a warm cartridge of prilocaine plain. We load it and inject it right then.

Howard: So they're in there. A lot – how many carpules does it hold?  

David: Maybe 50.

Howard: And they're in all day long? And does the warming speed  shorten the half-life of it?

David: It probably does but I haven't noticed a whole lot of problems with it. It might do it some so. But all I'm using that for is just the initial injection and then I follow it with something that actually works well because the prilocaine plain doesn't work very well on its own.

Howard: Do you do you put topical on before the injection?

David: I used to but I quit doing that because I felt I could do a painless injection without it. Now that sounds weird but even in the anterior some of these really – you might think real touchy places. With the right technique, small needle, very slow, very carefully with the prilocaine plain it's painless. It still is timeless.

Howard: Where were you born and raised?

David: Well, I was born in Newport News Virginia but I was raised in Nigeria and Niger. My parents were missionaries. So it's about an unusual childhood.

Howard: Wow. And how old were you when you – which one were you in first Nigeria than Niger:

David: Right. Nigeria first and then we were in Niger in the early '70s.

Howard: So how and how old were you in Nigeria?

David: Oh, since before I can remember up till I was about 12 or 13 years old, I guess.

Howard: Do you still remember so Nigeria?

David:: Oh yeah, yeah. I mean I grew up there as a kid. I had a great time as a kid. When you're a kid you're just along for the ride, it's fun.

Howard: Were in the capital Lagos?

David: No, no. We're in (inaudible 00:18:35) and Jos, Kaduna and there's a bunch of different towns, generally towards the middle of Nigeria.

Howard: And then you moved to Niger. Where'd you live in Niger?

David: A place called Maradi. It's right on the border, very pretty close to Nigeria.  

Howard: From age 13 to what?

David: Probably till I was, I think we came back she came back to the United States the last time when I was about 14. So we were only there in Niger for maybe a year and a half, two years.

Howard: Do you think that was pretty profound growing up in two other countries? Do you think that made you more worldly and well-rounded?

David: Yeah. In fact it made me just so grateful for the United States. I mean I know I get on the tell tale of the political forum. I am just a complete in love with the United States because I know what it's like elsewhere and the corruption and the problems they have elsewhere. We don't have nearly that kind of problem. And so it makes me  glad to go to work every day.

Howard: I know. Me and Ryan have lectured in five continents in the last 12 months and  when I hear people throwing America under a bridge, I just so wish they had to move to all these other countries. First to the countries that they came from. It's like really well, why don't you go back? Why?

Because when you lecture five continents in a year, my God, we're like there's very, very few countries. There's 220 countries and territories and islands and you could count on your fingers and toes which ones are worthy of living in.

David: Right.

Howard: That's only 20.

David: It's actually true and most of the time mostly the people that you'll hear them bad mouth the US but they all want to get here, it seems like. They all want to be here. So anyway, interesting child.

Howard: Yeah. That is amazing. So now when you moved back when you were 14 what city did you grow up in? What city did you move back and grow into because I'm wondering how did you end up in Lufkin? And do you think location and demographics matters to all these young kids that are coming out in less a year of dental school? Right now they're working in corporate dentistry. How did you end up in Lufkin and do you think demographics and location matters to your success?

David: I think it's imperative actually. We when we moved back we lived in Virginia but then my dad moved down here. My dad took the whole family down in the '70s and we lived in New Caney and which is just outside of Houston. And then I went to school in Houston. But I was glad we moved to Texas. And what – I had no one in the dental field so I had no real connections anywhere, no family in the dental field. And it I think it was kind of an advantage because when I got out of dental school I had the entire state of Texas to look at. And I wasn't afraid to go to any part of Texas and I looked at a lot of different practices and the one in Lufkin just seemed to click with me. I clicked really well with manning Dr. O'Quinn(phonetic 00:21:50) here. And it just it just seemed to click really well. And the price was right and he was going to retire. So everything worked out well. But the reason I was talking about location on that is I see way too many people piling up in places that are very, very difficult to make a living. And I think it's kind of tragic. I think if you see too many people pile together then you're fighting PPOs and all kinds of problems. I  understand why everybody wants to live in Southern California but not everybody can live there. It's difficult. And so  I tell everyone I can't see the ocean from my office or from my house.

But I can visit any ocean I want to pretty easily just because it's in a location where the need is there, that it wasn't as difficult to get started. I was able to buy real estate at a reasonable price. The taxes aren't too high. It's just a lot of things in the favor of dentists if they will go out a little bit and just take a look and see if they can make it make it in some of the slightly more rural areas in my opinion.

Howard: The millennials say I don't care. I mean they come out of UMKC. So they're spoiled to death living in Kansas City with The Plaza and Westport and the basketball teams and the Kansas City Chiefs and they're like – and then you show them that the people that are practicing two hours away from Kansas City have no competition, don’t have to do Medicaid, PPOs charged a thousand for a crown and get it. You're signed up for a PPO for 600. And gosh, it's such a game changer to go where you're needed.

David: I think so. I think that's super important. And I talked to some people, even private messages on Dentaltown. I talked to one guy who's having really trouble. And I will tell you where he was from but when it got down to it I said – and all the problem he is having – I finally said look, you just need to move. You need to consider moving. He says well no, I can never see myself out of this area. Well, to me if you can't ever picture yourself somewhere else, if you're never going to move, you've got problems sometimes that you cannot overcome. People used to move all the time. People used to move all the time for work. And I don't think dentistry is any different.

Howard: Oh my God. Yeah. No one even lived in the western hemisphere until 30,000 years ago. So we all came from somewhere. No one. But the bottom line is yeah, I've had this conversation before. I'll never forget one guy. He was in a very small town, it's 5,000  and the big factory closed. And people don't realize that in a town of 5,000 even though only a couple of hundred voted for that factory that factory paycheck was always keeping the restaurants going and the grocery stores going, and all this thing. And they kept telling me what I go to do and so you got to leave. I said, you got to move. There's nothing there because he was telling me all the demographics, everything that's going on and he said no, I was born here dude. I was born here. I'm not leaving this town. I'm going to die here.

And I said well, you're going to die there economically before you die of Physiology, Anatomy. And he said no. It took him two years and they had to repossession his house before he finally moved he end up moving only like to a town over. I mean he's only like a 45-minute drive. I mean  it's not the end of the world but yeah when – I tell him  if you're practicing in Syria and you had a chance to move to Texas would you say no, I was born in Syria. I mean  there's just some times when you've got to get the hell out of town.

I want to – they come out of school and you do a lot of Ortho and they all come out of school. They didn't get one Ortho class and the Ortho – the endodontist will teach these dental students and the oral surgeons will them extraction. The pediatric dentist will teach them (inaudible 00:25:55) crowns. But the orthodontist they have to have these minimum hours so they'll teach them craniofacial development. They'll go teach them all this stuff but not anything they can do in their office. What are your thoughts on general dentistry and Ortho?

David: I'm a big fan of it and I try to tell everyone to – the general dentist should at least, if they have any interest in it at all, at least do basic Orthodontics. And it takes some work because it's not taught in school. It takes you out of your comfort zone a little bit to go and take a lot of CE and everything for that. But it is well worth it. And with good trained assistants it becomes very profitable and you don't have to do them all. And I don't think some general dentists understand just how simple some cases are and which ones to take, which ones not to take.

And the only time I see general dentists get in trouble with Ortho is when they tackle things they shouldn't tackle, things that are meant for the specialist. I mean  (inaudible 00:27:00) class 3 is not something the general dentist really needs to be tackling unless you do it a lot. But my practice now is probably 60% Ortho and it's just simply grown on me. And the main reason is that (inaudible 00:27:16). It seemed like every kid needs Ortho. Every kid needs Ortho. Generally after a while every kid's going to probably need their wisdom teeth out. But not everybody needs veneers. Not everybody needs implants.

I mean the things that are the most needed is what I encourage other dentists to study and get good at.

Howard: And then I tell the orthodontists that every dentist I know that learns Ortho, most of them after –  most of them just become a better orthodontic diagnostician and are  more passionate about Ortho and there's just give and take to both. In your town, Lufkin Texas, what's its population?

David: It's about 35,000.

Howard: So how many orthodontists practice there?

David: There's two in one office and one in another so I think three total.

Howard: Now are they mad at you that you do Ortho?

David: Well, I don't know if they really like me  but I don't think they're terribly mad at me. But what they do know is that the orthodontic cases that I send them are special  cases. They're are ones that require their expertise. And so that's what I see with that specialty is that it shouldn't be like every other specialty.

Howard: Now do they appreciate those referrals because some specialists like I know endodontists that just hate people that only send them the broken file and a second molar. And they say, I like –  most specialists tell me, most all of them tell me that about 10 to 15 dentists or 80% of all the referrals. And then when they look at that other 20% that they don't really like the general dentist that does all the incisors and bicuspids and the initials. And all they send them is (inaudible 00:29:08). Now to those Orthos when you send them do they are like, oh my God this is coming from Dr. Palmer. This has got to be a flipping nightmare. And deep down inside I don't even want the case or do they like it.

David: Now I think they like it still and I get letters from them and I talk to them occasionally about the case but they do know that it's likely to be one that requires their expertise. It is it is probably not going to be a class one minor crowning case. Those I think that are so straightforward that I promise you after all these years my assistants could probably do some of them  and do a good job because they've seen it so much. As long as it's the right case, don't get me wrong. There's just some that are so straightforward that I think every general dentist should do because it's such a needed thing. There are so many people that need it.

Howard: So 60% of your practice is Ortho?

David: Yes.

Howard: That is amazing. So let's start at the beginning. Let's go through the Ortho journey. They're listening to you right now. She says I just graduated. I didn't learn a thing about Ortho. How would she learn Ortho?

David: There are some pretty good courses out there. The one in general I've probably taken, oh lord, 3, 400 hours. I don't know how many of just Orthodontics. But yeah,  the American Orthodontics society is very good. I thought that was one of the best, straightforward courses that tell everything and get you going in the right direction, teach you a lot about it. There are some other ones I've learned a lot from other courses too. I learned a lot from (inaudible 00:30:45) and even the late Dr. (inaudible 00:30:49).But in general I did take the Pacific Orthodontic course but the American Orthodontic course is the one that I would recommend and I don't have any connection to it.

Howard: Which one is that?

David: I don't have any connection to the American Orthodontics society the, AOS

Howard: Now is the AOS that's for general dentists that do Ortho?

David: Right. Right.

Howard: Who's the grand wizard of that group?

David: It used to be Gary when I was (inaudible 00:31:20), I'm sure. Yeah, it's Gary and then Dr. Jackson took over then he passed away unfortunately.

Howard: And when did he when he pass away?

David: Oh, it wasn't long ago. I've just taken a course from his and we were all the way down in Cabo, San Lucas and outside the course with Dr. Jackson and he passed away, I think, six months after that. I don't know what was the problem but yeah I was sad to hear that. You see he's a good instructor.

Howard: Oh my God, one of the best. So their website is orthodontics.com. I mean how old of an Ortho organization do you have to be to get orthodontics stuck. I still gnash my teeth. I started Dentaltown in '98. That was that was 19 years ago. And then you are one of the first what, 100 to join.

David: Yeah. I was going to tell you about that. That was interesting. When you when I first joined  there were so few people posting that when 10 people posted on a single thread a little fire came up.  Like this  one's on fire. This topic's on fire. And I look back now and I see threads now that are over a thousand pages. Things have grown. You've done a good job with it.

Howard: But it was funny because back when I started Dentaltown if you had an idea for a URL and like these guys decided well, let's just get orthodontics.com. It was available.  I didn't realize back then that I should have registered for like a thousand domain names because now in 2017 it is so hard to get a domain name. So orthodontics.com, the American Orthodontics Society, the AOS is the largest educational association of general and pediatric dentists have chosen that Orthodontists their practice, we are proudly providing the finest ADA and AGD recognized orthodontic education programs for over 40 years. That is amazing and that is Dr. Chris Baker, Joseph Smith Bauer, Leonard (inaudible 00:33:17), Bradford Williams, Jay Gerber, William Wyatt and William Wyatt's son is all over Dentaltown.

David: That's great.

Howard: Do you know who his son is?

David: No, I don't. I didn't know his...

Howard: Willy.

David: Willy. Oh that's Willy. Okay, I know Willy. Okay. That's right. That's right. I know. I remember he mentioned that.

Howard: And  his dad was one of the most famous orthodontist in Arizona. And Dr. Willy I'm always telling him, I'm saying, your dad's life work is on celluloid film and 35 millimeter PowerPoint slides in digital and it's your mission to digitize all that. I mean that guy's lifelong work, like Bob Barkley. I mean all of his work. L.D. Pankey. All their work and these kids come out of school and  the books, once  they got the book  there's something great to be said about digitizing yourself in a YouTube video  or something. I've already got – we've already got two podcasts that we did with legends that are no longer here. He's the founder of (inaudible 00:34:25), Bob Ebson (phonetic 00:34:24. Carl Misch . So I mean I felt so good. The only consoling thing is that when Carl Misch passed away was at least a hundred years from now there will be a two and a half hour interview with them on this podcast Talking about everything from A to Z because these guys are just legends. So you recommend that if someone's listening to this and they want to – I get more in Ortho that they should join the AOS, the American Orthodontics Society.

David: Yeah. I think that's probably the best one course. Now I'm not recommending one course in particular just take a lot of them because you learn something from everyone and I really delved into that very hard. I don't suggest starting Orthodontics without really working at it. Like everything else I think you should jump in with both feet. It's hard to to do it unless you kind of have a bigger picture. But I will tell you that the Bob (inaudible 00:35:21) really impressed me when I took it from him. He had some of the nicest finished work I had ever seen. And he also had a particular appliance that I'm not sure why everybody doesn't use it but it is a distalizing appliance. It's called the MDA. It's kind of a modified Wilson and it is the most impressive thing on what he can do with that. And by watching his work and the progress of his work it was the most eye opening course that I've taken and I immediately applied a lot of those principles in there and it's just been wonderful.

Howard: So his website is orthodonticteaching.com, the Gary Orthodontic seminars, orthodonticteaching.com. And so you're recommending that one.

David: I guess I haven't really looked at that particular one I just remember when I was there and he was teaching the course. Just looking at all of his cases were fantastic. And things that I didn't think would be possible, things where it seemed like a for sure extraction type case and he would simply make it work without it. It was wonderful. I mean the man knew what he was doing.

Howard: Yeah. And all those guys they didn't like the extraction and the reason with that is when I got out of school I mean it was just so – there were just so many orthodontics that basically do just fall on four. I remember some of these cases in 1987 where, my gosh, there was a minor crowding case and most of time the orthodontic treatment we're just taking a millimeter a month pulling back to cover that extracted space.

And so then the pendulum starts swinging and I would say back then half the cases, 30 years ago, were for bicuspid extraction and now I'd say it's 20%  So probably 30% of those cases went away.

David: Right. Right.

Howard: And the other one I recommend is Richard litt because most orthodontists won't teach general dentistry. Richard Litt is the only board-certified orthodontist. Oh and skip. What's.. Tip-Edge.. Harry Green.

David: Oh yeah.

Howard: Harry Green with Tip-Edge and Richard Litt of FORCE which stands for force, faculty orthodontic research, something, something. These are the only two board-certified orthodontists who will actually teach us low life general dentists and Richard Litt was the orthodontic specialty program chair at University of California San Francisco for years. Then he went over to Detroit Michigan. So at least if you're wondering say while I want to be taught ortho by a board certified orthodontist there's two choices for you. Harry Green. What about Invisalign. What percent of your Ortho is Invisalign?

David: I just don't do it. I started to do it at one time and I couldn't get a good finish.  it always seemed like I had to put a few low brackets to get the last little bit of tip and torque. So I don't know. I just don't have the skill in it. I've seen some great work on Dentaltown. That David Harnick is unbelievable with Invisalign. Yes, yes. I'm going to go visit him. My sister lives there and I told him I'm going to drop in on him. He is my orthodontic hero. He is really good.

Howard: And he posts on Dentaltown with those little guys.

David: Yes.

Howard: He's so amazing. He teaches he us. I mean all those  specialists do it routinely but very few orthodontists will mingle with us. He's an amazing man and my best friend at dental school, Craig Steichen is in Albuquerque too. Albuquerque is awesome. Big shout out to Albuquerque. Or  you should do. You should charter a fishing boat and boat from Houston to Costa Rica where the Invisalign factory is. You should deep sea fish all the way to the Invisalign factory.

David: That would be fun.

Howard: So another thing you do. You do molar Endo on wisdom teeth. When I go into these dental schools they haven't even graduated yet and half the class tells you, I hate molar Endo. What would you say to a kid that's coming out of town coming out of school and she got $350,000 student loan then she already hates Endo?

David: It's one of those things. Like I said I think it's common sense that you do. What is the most needed? And let me tell you there's a lot of people that need molar Endo and if you just pass on all of it you're just passing on everything. If you – I think people that hate, sometimes hate things they're simply a little out of their comfort zone. They haven't done it enough. And if they do it more and more sheer repetition alone will improve their speed and their confidence. And before long, molar Endo,  it's never easy but it's a whole lot easier than it used to be.

And I mean if you cannot – one of the things that I think kind of freaks some people out that (inaudible 00:40:39) is that I literally – learned this from you the capacity thing. I have enough chairs and well just today had someone coming in and  he had – number 18 was just killing him, a big hole in it. We worked in an entire root canal and  build up and a crown around everyone else. Now it wasn't easy to do but it's something that if you work on your molar Endo, if you work on these kind of things and get them down to where you can do it quickly you probably remember that time we went to Scott Perkins' place and I learned a lot from him just efficiency techniques. If you can do that...

Howard: So it's you, me and Jerome Smith were there.

David: Yes.

Howard: God, how many years ago was that?.

David: Stephen Glass was there.

Howard: Oh that's right, another Texan.

David: You bet. You bet.

Howard: Where's Stephen at?

David: Stephen's in Houston. I think he's, going to say Spring but I'm not sure. I think he's around Spring area.

Howard: He hit by the hurricane?

David: Yeah, but not too bad. I think he's okay. I don't think it's flooded anything for him.

Howard: God, I love all those guys, Jerome Smith, Stephen Glass. You talked to Scott Perkins lately?

David: I haven't I haven't. But Jerome Smith is another big hero. He is unbelievably skilled and  his implants are just – I mean I learn more from him from implants in any course I've ever taken.

Howard: And you know  what's so damn cool about Jerome Smith. I mean I can't even say this without getting verklempt. When he does those over the shoulder hands on implant courses he just does it because he fell in love with all these people on Dentaltown. He wants to give them a over the shoulder program. But you know what he does with 100% of all the tuition money?

David: What does he do?

Howard: He donated to support a dental office charity down there in (inaudible 00:42:29), Mexico.

David: That doesn't surprise me knowing him.  

Howard: I mean, my God. He just wants to teach. He wants to help all these people he talks to Dentaltown and they thought, you know what, I'm just going to take all the toys (inaudible 00:42:46). So he's just amazing. What year did Jerome Smith and Stephen Glass and you and when did we all go see Scott Perkins?  

David: I don't remember but it wasn't even official CE. No one got a credit. But we did it.

Howard: I got to tell it to these young kids that story so what would you guess? I mean if you had to guess what year, this is just 2017. What would you guess?

David: Mid '90s, late '90s, somewhere in there.

Howard: I was thinking like '98 maybe.

David: Probably.

Howard: 2000. You think it's before 2000?

David: I think so. Maybe before 2000.

Howard: So this guy actually ends up getting me in more trouble than any dentist ever did. He wrote an article which I loved because I know (inaudible 00:43:34) on the board and no one got it. It's called the 50-minute root canal.

David: Right.

Howard: So all these orthodontists sending me all these letters, oh my God, Dentaltown is just a garbage site . They're telling these dentists. They can do a molar root canal in 15 minutes like you didn't even read the article and you didn't even meet Scott Perkins. But I mean is it was operations and logistics symphony like you take it down. I still use rotary and don't go down there.

So they do top down or bottom of a dome or says they got to start the bottom with the 15. And then they're done. And then they have to take out the file then they change it and they put it in the napkin. Then they get the next file and they load it and Scott's time and then it's like well dude you just spent two minutes doing that. So he set up like four slow speed engine driven. So when he walked in the room (inaudible 00:44:21) the 15, the 20, the 25, the 30, the 35.

That was all laid out. Then when the guy sat down he looked at that molar in a rubber down with his loupes on and he never took his eye off the tooth. And he had two assistants. And he basically did exactly what every endodontist does in an hour. But his operation logistics was so absolutely perfect it would only take him 15 minutes.

David: Absolutely.  I think...

Howard: And we saw with our own eyes, didn't we?

David: Right. I mean how do you argue with a video? He has a video of that and it's very well done.  If you don't see it you can't think it can be done. But he was – he has  efficiency genius from his crown to that. He was just an efficiency genius. That's what he excelled at. And I told him I needed to find I asked him if he could do an efficiency on – post your composites. and he said, no,  no, that's too many steps in too many places. I got to stop. That's a hard one for him. But he has he is really something.

Howard: Yeah. I mean  these people – I read a (inaudible 00:45:28) today that on Facebook when someone shares a new story it's like well over half the time. They never even open the story. So they just read the headline and shared it. And like we said with Scott Perkins these endodontists writing some of the most hateful letters in the world. And they didn't even read the article or see the video. And there's not one endodontist, 4,000 endodontists in America, and there is not one of them that is as efficient as Scott Perkins.

David: No. I think sometimes some of the specialists underestimate people like Scott Perkins and others who really get focused. And he gets this tooth out on a little vice (inaudible 00:46:08) and works – he puts (inaudible 00:46:09) with hot bleach. He's doing research and working every day on stuff that they are not working on and eventually he can get to where he can master something. And I just don't think he gets a lot of credit and I felt kind of bad that he did catch a lot of heat for that. I know he didn't take it too well sometimes.

Howard: Well,  the bottom line is no one ever criticized you. You're not a pioneer. I mean if you're really a pioneer you got some arrows in your back and you don't have any arrows in your back. You're not a pioneer. Because whenever you do anything new someone's not going to like it. And Scott, I mean Thomas Edison failed 10,000 attempts at a light bulb. And what I love the most about Scott  Perkins is that his intellectual curiosity about dentistry is insatiable and he's not going to sit there and wait till the ADA convention to go see what some swigger tells him to do. He's sitting there staying up till midnight  doing it himself on extracted teeth on a bench and I just love his passion for all things operational and  you know who reminds me of him?

I mean look at the McDonald's brothers. Before Richard MacDonald out there in Southern California, out there in Downey California, 100% of all the restaurants in America took one hour to sell you a hamburger and a can of coke. You go in there you had to wait to be seated. And then we were seated some waitress come take your drinks. And then what?

And then when they brought your drinks then they take your order, a hamburger fry. Then they go give it to the cook and then she'd bring and then when he rings the bell they bring a basket and a hamburger and fry. That was 45 minutes after the hour. So now you're down to 50 minutes. So you eat it for five minutes and then you're done. And then you get up and you leave.

And it took an hour. And the McDonalds, Richard McDonald looked at that process. He said, you know  what? You should not take longer than three minutes. And it was because we're going to leave the grill on and we're going to put the grill here. Why?  He eliminated all the waste and the waste was 57 minutes out of an hour.

And these endodontists wouldn't even listen to Scott, take in just 45 minutes of an hour. I mean that McDonald's brothers took 57 minutes out of the hour. And furthermore if you're patient centred, if you needed a root canal would you rather be in the chair for an hour and a half or one minute?

David: Yes. I'll take I take 30 seconds if that can be done.

Howard: I know and there's so many self limiting beliefs and one of them in dentistry is that if you go fast you're sloppy. And if you really are meticulous like a Rolex watch it's going to take 40 days and 40 nights to do a filling. And I just don't see evidence of that. I mean there are fast sloppy dentists but they're just sloppy. But there are fast meticulous dentists who got religion on operational logistics and do everything easier, faster, higher in quality, lower in cost.

David: I tend to think that's more of the case too because I kind of liken it to the heart surgeon. You want to see the heart surgeon that does 20 a day, not one every six months. The guy does 20 a day is so fast and so efficient. He's done it so many times that he's going to do a great job compared to the person that does it every once in a while. So I just remind people when they're in –  if you're in dental school how long did it take you to do your first filling versus now or your first crown versus now? and is it better? And are you going faster and is it better? So everyone just – sheer repetition, I guess it is quite a teacher itself.

Howard: Yeah. Same thing with dental lab. You want to pay a dental lab $120  and seat every crown in three minutes or you want to pay $80 and spend half an hour adjusting it? They just don't know their cost. The quality a crown, I mean come on, adjust margins and contacts and occlusion. I mean you don't need a eegee board to figure out your (inaudible 00:50:12) lab. I mean this is the margin there. And most of the margin has to do with did you give them a good impression or not. Are there contacts there or are there occlusions there? But I'm looking for the lab not based on price but the one I don't have to adjust.

David: Absolutely.

Howard: Yeah. So going on to oral surgery. There are just so many people that come out of dental school and they go I just want to be a cosmetic dentist and do bleaching, bonding the veneers because I don't like blood and I don't like oral surgery. How did you get into wisdom teeth? Where did you learn that? Did they actually teach you that in dental school?

David: Not really.  In general wisdom teeth were taught I mean were done by the oral surgeon there. And you got to observe but you rarely got to do anything, of course. But I'll tell you one of the things that helped me the most, I think it was actually a video. It was the Productive Dentist Series.

Howard: Bruce Baird.

David: Was that where it is?  It was a couple of Canadian guys and I don't remember. It was called the... it was a videotape of it. Plus there was also  good CE.

Howard: Oh, that's right. What was – The Productive Dentist Academy, Canada. Yeah that guy came to stay at my house.

David: Right. Literally his wisdom tooth part in there was incredible. And it was so helpful I'm just figuring out what to do and what not to do. And you just take in a videotape and watching it over and over. And then kind of getting a little out of your comfort zone just the ones – you got to know what you're doing. You got to have the right equipment.

Howard: It's on Productive Dentist Academy.  That's Bruce Baird in Texas.

David: Okay. It was a couple of Canadian guys that got that together. They had their videos too, some on Endodontics.

Howard: Do you remember that name or you got anything in your office that had that deal or...

David: No. Sorry, I don't. I wasn't ready for that.

Howard: Was it The Productive Dentist?

David: Probably so. That sounds like the right one. But I don't think it was – it wasn't Bruce Baird. I know him, it wasn’t him. But it was just a couple of – yeah it was just two Canadian dentists. Of course they always say freeze – you froze it instead of getting it numb.

Howard: It was John Lyons, the president of Productive Dental videos. I wonder how he's doing. Can I can I tell you my funny story about that guy?

David: Sure.

Howard: So he calls me up and this is way back in the day because I was on the last house when I lived on the golf course. And this Canadian comes up and he says he wants to meet me and he's asked name the hotel. And I said well, you stay at my house but here's the hotel. The Arizona Grand is the nicest resort which is about one 1.0 miles from my dental offices. He goes, are you serious you'll let me stay at your house? I go, yeah. But on that note I got four baby boys. I think at the time they were like one, three, five and nine. I said  you might get hit over the head with a baseball bat and a black eye because they were just completely crazy.

And he goes, no problem. So he comes stay the house. But it was in the middle of winter. He did over Christmas break and we got a swimming pool and in Phoenix you know  who was born in Phoenix during the winter. They wear a jacket and a hat. And you always know who the snowbirds are because they're out there walking around town in shorts and flip flops and you're looking at these people like, are these people out of their freaking mind?

So he comes to nobody in Arizona ever swims in December in a unheated pool and that guy goes, oh my god, a swimming pool. I want to go swim. I go, no, no, no, no. it's not heated. He goes, I don't give a shit if it's heated. He goes it's 68 degrees out. That’s warm. No, dude. This is winter and you can't jump in that pool. He goes out there and dives in the pool and he swam around. So finally I think to myself, okay, this is all in your head. It's all in your mind. The Pool's not cold. Look at Dr. John Lyons, he doesn't have a problem. Put on your big boy pants. So I said okay, I'm going to dive in there. I almost died.

David: Oh my God.

Howard: I mean I almost completely died. And when I came out my teeth were chattering like rocks while he's laying out. Then he wanted some sun. He goes, I want to go back to Canada with a suntan. I was like man there is something about conditioning  temperature. But I love that guy. But back to the how do you learn how to pull wisdom teeth, does he still sell those videos?

David: I don't know. I don't know. I just remember that was one of the main things that I was learning – I will say too. I had an older dentist when I started. And he was very good at oral surgery. And so he was kind of – it was helpful and he was backing me up. He would encourage me to do some things that put me out of my comfort zone. But he was still looking over my shoulder in case I got in trouble. And that was very, very helpful. That was an older dentist, Dr. Quinn ( 00:55:35) and he retired shortly after that. But he told me stories when he first moved to Lufkin.

There were no oral surgeons anywhere around. So there was no one to refer to. So he had to tackle most of them himself. And he was very well self-taught. But he taught me a lot. And then that that video series and then just slowly getting ones a little bit more difficult until you can easily figure out which ones to tackle, which ones not to because that's another one. That's another common sense thing. Everybody's going to need that one day. Most kids need their wisdom teeth out. It's rare for everyone to have perfect wisdom teeth to come in so that's such a needed thing that is needed far more than, say, veneers or implants or something. That is, if you learn how to do wisdom teeth and do it well then you're going to have a natural flow of patients that come to your office as they grow that need their wisdom teeth out.

Howard: And the reason I love wisdom teeth a thousand times more than I love Ortho is because wisdom teeth is instant gratification. You either get them out or not an Ortho case can be a year or two. And the other thing is you hate everything in life that you're not good at. Like you don't see me going out and trying to be a singer because I know I can't sing and it's not people's opinion that I'm not a good singer.

It's biological because when my boys were little they were like one-year old I'd be rocking them to sleep and I would sing to them. One of the first words they learned is reach over their hand put on my mouth and say, Daddy, no. I thought, damn, if a one-year old knows you suck at singing. This isn't somebody's opinion or preference.

But, so the first wisdom tooth takes you an hour. Well, maybe the next one takes you 55 minutes. But after you do 100 anything, whether it be molar Endo and this – after 100 and you're maintaining a repetition of one unit per week – if you're not doing it once a week get out of it because you're not going to get good at it. That's the bare minimum in profitability and excellence. Furthermore, I wouldn't want to go to a doctor and get a vasectomy if he only did it once every other month. I mean I don't want to go to the guy that does the most of them.

Have you also talked about dental implants. Some people are telling these dentist that they all get to learn how to place implants. You're saying, hold on. Not everybody should be placing implants. What's your thoughts on that?

David: I think it's exactly what you're talking about, that doing something once a week you can start to become proficient at it. But there's such a small number of implant cases and people willing to do implants that if every single general dentist decides to do implants, there simply is not going to be enough to do.

I mean I (inaudible 00:58:31) implants and I've learned most of it from Jerome Smith. And the problem I found with it is that I do so few of them that I cannot make myself comfortable and proficient with it. So I've pretty much slowed that down to where I do maybe a slam dunk implant every once in a while. But I just don't think it's profitable. I think it's one of those things that one general dentist can do in a group and people will refer to him.

The oral surgeon can certainly do them, periodontists and staff. But if you have every single general dentist trying to do all implants you'll find out there's not that number of patients available for that. It's expensive and there's no insurance generally. So  I've always said,  Bubba (inaudible 00:59:20)his tooth out for 20 years is not interested in getting it, one implant in there but he'll certainly pay for his daughter to have braces. He'll certainly pay for his daughter to have the wisdom teeth out. Those two things are common as dirt but implant procedures are not.

Howard: One of America's greatest cardiovascular surgeons of all time was down there in Texas, Dr. Michael DeBakey, and down in Baylor and he was about the greatest. And his grandson was on my floor – I was on the same floor as him, 9th floor Swanson from '81, '82, I think, '83.  And his name was Joseph DeBakey and we used to talk about his grandpa and I say, why do you think it was him?

And he said well the usual stuff, the intellectual curiosity, all these. But he said dude, those surgeries back then with their equipment took six hours to do a bypass. And he did three a day seven days a week. He did one from six to noon, noon, from one to six. And one, 6 PM to midnight. Then he'd go home and sleep six hours.

And in his surgery room they didn't have all the equipment back then that you could buy from Patterson in China, Benco and Burkhart  for all the stuff. He had his own sewing machine in the surgery sewing up these pads. I mean talk about a Thomas Edison. But I mean this guy was doing 21 bypasses a week, year after year, decade after decade. That's how you become the number one cardiovascular surgeon of all time in America. And I mean he had some of the most famous people in the world flying all over to have him do his heart. So then what, does that apply to you? So now you're trying to get in to sleep apnea and you're doing one case a month. Would you rather go to the sleep apnea guy that's doing three cases a day or once a month?

In 1900 there were no specialists and doctor did everything from your head to your toes. And the trajectory since that has broken up  medicine into 50 specialties. Dentistry into nine. And you got to get repetition, repetition, repetition. And if you're coming out of school and you say I'm going to master Endo and oral surgery and implants and bone grafting and Invisalign and bleaching and bonding and be a cosmetic – and if you're going to be everything you're basically going to be a 1900 dentist. So you can't master everything. And when a lot of people are saying they want to add this I always say, well, what are you going to subtract?  I mean you know  how hard it is to keep up on Implantology.

David: I just find it almost impossible. I get tired of all the different choices there are per se. Just don't sit on a single implant

Howard: And then sleep apnea. I mean that alone. I mean I've already podcasted three different dentists. And when they realized how complicated it was and how intense it was they decided that they were only going to do that. And they dropped all the clinical fillings, crowns, X-rays, everything and they only do sleep apnea and they're not in rich places.

I mean these dudes are in Tennessee and Kentucky and I mean these aren't in the same Beverly Hills stuff. This is real world dentistry  – but I'm just saying that there's so much information out there moving at a speed like we've never seen before. You're not going to master everything. You're not going to be a jack of all trades, doctor. That's come and gone.

David: I think you're right. And  whatever you're interested in I think you should try to master or try to get good at or the things that are the most commonly needed. And if  the dentist come out of school will simply get the best and really work hard at trying to get the things that are most commonly needed it will help them a lot.

Howard: You credit me with teaching capacity. What did I say about capacity that changed your practice?

David: Well, I was in another smaller office and a hygienist had two rooms and I had two rooms. And it was so stressful because there was always – it was always hard to have an open room. It's always hard to work someone and to have any little adjustment or something problems. And I watched your 30-day MBA and talk about capacity talking about how the – Wal-Mart doesn't open up all those lines except a couple of times a year. Same with  the grocery stores. But when they need them they need them. And restaurants,  it's empty most of the time but they got to have enough room when they need it. And when I built another office we put 7ups in here and it is been so wonderful to have open chairs and things so that people can come in and I can do little things and we can work so many other people. And it t is so much easier. It has actually lowered my stress level tremendously by having enough chairs. And anyway, that was it. It’s the capacity thing. We don't always have five chairs full but it's not terribly uncommon with the bunch of Ortho kids or something. But we generally are working at three and four chairs a lot. And that's become comfortable for me. But when I first started it wouldn't be. It would have been almost...

Howard: And when you go to any grocery store. They'll have 12 checkout lanes and most of the time there's only two open. But they know their cost. And they know their cost in  checkout lanes and when they get swamped someone gets on the speaker and says “I need all the checkers in the front. All checkers to the front” and they run out they man their stations, they work the flow.

Same thing with dirty rooms like sometimes you don't have time after you dismiss the patient to clean up the room, you're running late. Just leave a dirty room because you got other rooms. And then that room – every room should be Southwest Airlines, Boeing 737. You should be able to go into every single room, every single drawer is exactly the same thing. So if I'm in the hygiene room in most offices I say gosh, you just need filling. You don't want to come back for a filling. And it's just a little filling, you want me to do it right now? 99% of dental offices say “We'll have to move you out of this room because this is my room.” So what do you want me to do? Go set up another room and get the patient up and move into another room. We just lost 10, 15 minutes, a lot of disposable supplies. Why don't you hygienists go to another room? And she's like, well because that room doesn't have a (inaudible 01:05:49) cup in draw number three. We'll make every day, every room the same. Can you imagine being seated on a flight on Southwest Airlines. The pilot gets on the plane and says, extension all passengers. All 120 of you have your luggage checked on.

I just realized this is not my plane. In my plane in the drawer over here should have a ballpoint pen. So I'm going to ask everybody to get off the plane and uncheck your luggage and go three planes down because this room can't do a filling because it doesn't – it's like it's just operations logistics, logistics, logistics. Sometimes these people have two or three extra rooms and they didn't have time to clean them but everybody fought on time. And another thing on patients' mentality, on their mental health. If you're running 15 minutes late and they're waiting in the waiting room for 15 minutes they are pissed. But when you got extra rooms you seat them on time and then you go numb them up on time. And you say Mrs. Jones you know what I'd really like to do? I'd really like to do this so that you don't feel a thing and I'm going to set a timer for 15 minutes. I want this to soak in so it doesn't hurt. She's all happy. So preprocessed, wait. Piss her off and she might not ever come back. In-process, waits. She thinks something's getting accomplished. People don't want to waste time. So if they think something is getting done they're going to love it.

Last and final, man. We're like two schoolgirls on the playground talking and we've already got over 10 minutes. Can I ask you one more question even though we got over 10 minutes?

David: Let's go.

Howard: Final question. How do you keep people from stealing your services on the collection policy? How many times have you done a filling and they get up front and they say, you know what? Bill me. And then never pay.

David: Well, yeah. I learned that from you too, by the way, I'm saying. Just like in the fast food business you give the order, take the money, give the food, right? So what we have done is same scenario, we talk about it. The patient agrees. Okay, we're going to do this filling or this crown but I certainly don't want to be doing the crown and guessing whether or not the patient is going to be paying me or not. We were never getting that position anymore at the office. But the one thing I take it a little step further is that some people think it's kind of strange. But I think the most, the best time to collect is simply after you've discussed this, say, the patient this morning that needed a root canal. They agreed to do it. Everything's fine. Okay that's fine. We've already talked about the bill, they agree.

Well, then I get the patient numb and then I simply tell my assistant. I tell them or tell the patient, hey, now Karen is going to help you up front here to take care of some of your paperwork and your next appointment. So while this is working in we're not wasting time. Then we simply escort the patient up to the front. They pay and then we see them back down. And what I found is that that little time while you're getting them numb is very valuable because every once in a while you'll have someone trying to stiff you.

And if they're really trying to steal from you they're going to go to the front they're going to make a big scene and pay. That means they were trying to steal from me or they'll go up to the front then certainly say, well I'll have to be back in a minute. I don't have it. So it sounds kind of strange to some but I tend to numb first, let them pay, they get back in the chair and we start. Now that's a little bit off what some people do. Sometimes we just have them pay beforehand. Obviously if anyone owes anything, when they come in, say, we've got to see a bridge or something and something they still owe on it for some reason, we have them pay that before they're seated. So, anyway it works very well as long as it's not something that appears rude or uncaring. And it's been really good.

We don't have a problem with people – obviously, we don't have a problem with people  trying to steal our services. Anyone that does something like that and leaves because they're trying to steal from you they go tell their  scumbag buddies that, hey, don't go over there. You'll get numb and nothing will happen. These are people they're trying to steal from.

Howard: More what percent – you're in Texas, the Lone Star State. You're in a town of about what, 5,00, you said?

David: About 35,000.

Howard: Thirty-five, okay.  

You're in a town of 35,000 in the Lone Star state about 80 miles north of Houston

David: Right.

Howard: What percent of the people in your hood do you think or would intentionally try to not pay for – steal your services.

David: Oh gosh. It was more when I first started. I guess they wanted to take advantage of me when I was younger. But I would say it's very – it's well under 1%. It might be well under point 0 something percent. So it's not a lot. It's not a lot at all.

Howard: I mean what percent? What percent? Either it's under 1%.

David: Oh, yeah. Yeah. I would say...

Howard: That's now when you're 55. But what about when you were – opened up 30 years ago?

David: Oh, yeah. When I opened up 30 years ago and I was much more gullible. I would do – I would overproduce and not collect. I would do the work and then sometimes people would simply say, bill me or I'll be back or I cannot...

Howard: But out of 100 people when you just started out. Out of 100 people how many would you think would try to take advantage of you?

David: Only 3% or 4%.

Howard: Yeah, exactly. That's right, I agree. So the bottom line is – so the average overhead is according to ADA it's 2/3. It's 65%. So let's say I'd say it's about five. It's about one in 20 Americans. So if you do that 5% while you have 2/3 overhead, so that 5% you didn't collect cost you a dime to make. So 10% of your overhead is just the collection policy. And would I have convinced that 30 years, a couple of things. One in 20 people have no intention of paying. And those are the only ones that scream and yell about your collection policy and the old doctor never get bad money.

Well, yeah because they just don't want to pay. You can't go into a mall and get a wedding dress and I'll walk out and pay it or get tennis shoes or – you can't go anywhere. You go into McDonald's and order a hamburger. This 16 year old high school kid says, well give me three bucks. You say, oh I don't I have three bucks, just give me a hamburger. I'm going to eat and then bill me. She'd laugh. But who has this problem? It's the young dentist.

And we're older and sharing our stories on these podcasts for free with these kids so just that don't learn lessons the hard ways. I mean we don't read books and autobiographies. You only live one life. If you read 100 biographies such as the autobiography – you'll live 100 lives and the only people that complain about that collection policy are people who never want to pay you. And if I tell you, you need a crown our office is really good in insurance verification and all that so we know we have a ninety 99.8% collection policy. So we know what your insurance can do. But we say your portion is 100 bucks . You give us 100 bucks and then we do it. They say, well, just do it and bill the insurance and we'll see what they don't pay and then bill me. No.

We know what the insurance are going to pay. We do this all day every day. Your portion is 100 bucks. Then they say, well I get paid on Friday. Well, great. Let's go up front and find an appointment sometime next week when you got your pay. Well, no, I want to do it today. We'll take your credit card. I don't have a credit card. Well, do they give every American a credit card application when they're prenatal. I mean if you look at those ultrasounds close enough you could see that  Chase one card in their hand. So if Chase won't give you a credit card why the hell would I give you a credit card?  But I'm telling you young kids one out of 20 Americans, I can't speak for Canada and Mexico, but one out of 20 Americans are trying to not pay.

And just like a lion when he sees a herd of gazelles  will he go after the strongest fastest gazelle? He looks for the old one. He looks for the wounded one and then they try to separate that guy from there and kill it.

And in dentistry predators sit there and see that new dentist open and they say, oh she just graduated in 2017. I'm going to go there. I mean they are predatorily seeking you out. So order a cheeseburger. Give me three bucks I give you a cheeseburger. Your collection should be 100%.

David, You are so damn cool. I love you to death. I feel like I know everything about you. By the way your avatar says that you signed up in 2000. That's because we didn't set – when we started in '98 we didn't set the timer. So the all of the old dogs are listed like the first 100 or so. You don't have the same registration date and whenever I see a guy like you with that registration date that means you are already a member where we programmed in the timer.  

David: That's good. I got you. So we speak the same language, Howard, we do. I mean I was really impressed with what you did and then setting all these up and especially Dentaltown and I was trying to be a little encouraging especially to the young dentist and those in dental school. There's a lot of negativity, sometimes on Dentaltown. But these kids if they come out make common sense choices, don't put yourself in debt, don't spend more than you make. Just a few common sense things, they can do very well in this profession and it doesn't have to be such a grind. It's frightening to see some of the stories on Dentaltown. I'm not trying to encourage some of those younger dentists in particular to hang in there. It does get better. Things get  – the more you do it the easier it gets. Dentistry is a lot more fun for me than it was when I started. It's just more enjoyable because there's less things that can fool me. There's less things. I know what I want to do. I've gotten better with my staff I've gotten better with patients and so just over time things tend to get better and that's what I'd like to just basically  leave it on.

Howard: And kudos to you man because Dentaltown is like the only AA meeting for Dentists. It's the only place you could go and say, my name is Howard Farran and I am a dentist. And I'm stressed out because la, la, la, la. And it's guys like you that are Dentaltown. You've posted 9,321 times and you have shared so much. I mean every day when people go to Deltown it's like you don't go to an AA meeting. An AA meeting would just be like if you went to the church and you're the only guy there. when they go there they're expecting guys like you to be there. So from the bottom of my heart thank you for always being there for two decades. And those are just your posts, all your private messages.

But I mean when I think of Dentaltown guys like you are just so amazingly special. Thank you so much for not only all of you do for your patients and for dentistry but thank you for all that you do for Dentaltown.

David: I appreciate it, Howard. Thank you so much.

Howard: And you have a rockin' hot day.

David: You too. Have a good one.