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Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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How to perform dentistry faster, easier, higher in quality and lower in cost.

960 Lessons from D3s with Olivia Sugimoto, DS & Taylor Velasquez, D3 : Dentistry Uncensored with Howard Farran

960 Lessons from D3s with Olivia Sugimoto, DS & Taylor Velasquez, D3 : Dentistry Uncensored with Howard Farran

2/28/2018 8:41:04 AM   |   Comments: 0   |   Views: 103
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960 Lessons from D3s with Olivia Sugimoto, DS & Taylor Velasquez, D3 : Dentistry Uncensored with Howard Farran

Olivia Sugimoto is a third-year dental student and ASDA President at Midwestern University Arizona.  

Taylor Velasquez is a 3rd year dental student at the Arizona School of Dentistry & Oral Health pursuing his DMD and MPH. He is originally from Albuquerque, NM and graduated from Arizona State University. Go Devils! He is married to his wonderful wife, Brooke and enjoys playing golf whenever he has a chance.



VIDEO - DUwHF #960 - Olivia and Taylor



AUDIO - DUwHF #960 - Olivia and Taylor

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960 Lessons from D3s with Olivia Sugimoto, DS & Taylor Velasquez, D3 : Dentistry Uncensored with Howard Farran

Howard: It is just a huge honor for me to be podcast interviewing two dental students from right up the street, Olivia Sugimoto and Taylor Velasquez. I thought this would be a really fun show. Most people tell me they have an hour commute. Say you're coming home from work and you just got your butt kicked by a molar root canal. So we podcasted the twenty-five greatest endodontists. Say you're starting orthodontics or Invisalign. I've done the twenty-five greatest orthodontists or more. I mean we've done a thousand shows.


I'm really excited to have you on there because 25% of our listeners are dental students. 5% are pre-dent, which I can't even imagine being pre-dent having access to a smartphone and all this technology that you guys have which we didn't have 30 years ago. So I thought this would be really great to have dental students. They're both third year dental students at Midwestern.


Olivia is a third year dental student and the ASDA - that's Arizona State Dental Association? 


Olivia: American Student Dental Association


Howard: American Student Dental Association president at Midwestern University. So you're already into politics. 


Olivia: A little bit, yeah.


Howard: Does that mean when you graduate you're going to run for mayor? 


Olivia: I don't think so at this point.


Howard: You don't think so? I think it's beyond evident that anyone can be the president of United States. So you got to shoot for the top.


Taylor Velasquez is a third year dental student at Arizona School of Dentistry and Oral Health, pursuing his DMD and MPH, which is a Masters in Public Health. He's originally from Albuquerque, New Mexico, home of the world's greatest dentist, Craig Steichen. Do you know Craig?


Taylor: I don't.


Howard: Oh my God. He did all my lab work in dental school. That's why I got A's in lab. I wax up my denture and Steichen is just like, "Oh my God." He would redo the whole thing in like ten minutes and I get an A. He graduated from Arizona State University, so did I. Good job, Sun Devils. He's married to his wonderful wife, Brooke. Is that Brooke Shields? 


Taylor: No. Nope.


Howard: That's [inaudible 0:02:04] meant to be your mom, right. Enjoys playing golf whenever he has a chance. What is it with dentists and golf? My God. 


Taylor: I don't know. It's competitive. It's not that hard to do. Not physical training as much. I used to play little sports. So now it's a little more relaxing.


Howard: Now, you're tall. How tall are you?


Taylor: Six-four. 


Howard: Do you think the six-four frame in physics has a better longer? How tall was Tiger Woods?


Taylor: Tiger is like six-one maybe, I think. 


Howard: So you think tall people? Because in swimming, it's the most physical. In basketball, you got to be tall. But if you look at all the aircraft carriers and submarines, they're all long. You look at all the gold medalists. They're all like six-three or six-four. You got to be that shape. When you're a short, fat, guy like me, you're like a barge going down the river, pushing all this water back up the river. A lion would never drive drunk, but at tiger would. 


On that bad note, so you're a third year. You had four years undergrad, all academic. You had two years of a dental school, all academic. Now, you're finding out that you're going to be a surgeon the rest of your life and work with your hands. How's that feel? Is it very stressful? Are you are you hanging in there?


Olivia: I think it's a little stressful because there's so many things to remember. Taylor, you probably feel the same way that you're just trying to think of everything, and it's sometimes easy to get focused on an individual tooth. You still need to think big picture. So kind of wrapping your head around everything can be stressful, but it's coming along. 


Howard: Well, this is February. So you've been working hands-on for how long? How long have you been doing hands-on? 


Olivia: Since June. So it's like about eight months. You too?


Taylor: Yeah same. June.


Howard: Eight months. I think the worst crime in dentistry was that clear back in 18 - what was it When was the University of Baltimore? The University of Baltimore is the first dental school ever, and they were building the school. What was it? 1840. Pretty much all the physicians needed beds, but they specialized in dermatology, ear, nose, and throat, surgery and stomatology, but the stomatologists wanted chairs. Because of the bed to a chair, they separated the school. Dentists were separated, which I think is so horrible because when you look at physicians, 80% of them don't need eye-hand coordination. They're just listening, running tests, writing scripts, doing diagnostics. But dentistry, we're all surgeons and we work in an operatory. It was very, very clear to all of us old guys that a lot of people didn't have any hands. 


I'll give you an analogy. I can send you to art school, painting school, for eight years, and you can be the worst painter in the world. Then here's this twelve-year-old little girl over here with no lessons and she's doing all. I mean her art will just blow your mind. That's what I felt dentistry was like. 


The reason that’s a curse is because in physicians if they're in surgery and they don't have hands or they don't like working with their hands, they can just go do something else. But in dentistry, what are you going to do? But if dentistry was still back in the MD program with physicians, then you could sit here and say, "You know I did a residency in dentistry or stomatology," like the Russians do it that way. In Russia, if the dentist, say he loses an eye, he loses a 3D perception, or he loses an arm or whatever. They'll just go do a residency and a fellowship in some other branch of medicine. You guys are surgeons. Anybody in your class wondering if they had a set of hands or not? 


Olivia: I don't think so. 


Taylor: No, not yet.


Howard: Not yet? Well that's good. China just placed the first dental implant with a robot. 


Taylor: Yeah.


Olivia: Whoa!

Howard: So when I talked to those companies and there's a couple of companies and Florida has a lot of companies. They really think that even the drilling of the tooth within ten years you'll just be manually setting it up, doing the diagnostics, but actually a device will go in there and do it all. What are you passionate about now, Olivia? 


Olivia: At Midwestern, we have a partner system. Third years and fourth years are paired together for the year and work together in clinic. I've gotten a lot more passionate about aesthetic work because my partner is really good. That's like what he loves. So we get a lot of aesthetic cases. We did some composite veneers together last week. We do CAD/CAM custom staining. 


Howard: You did composite veneers.


Olivia: Yes.


Howard: So you did direct composites.


Olivia: Mm-hmm.


Howard: Yeah. I got so many so many rants, it’s hard for dentists to say they [inaudible 0:06:52]. It's funny because a lot of dentists do veneers where they prep back the tooth, take an impression, and make veneers or CAD/CAM the veneers or whatever. But you see those ten, twenty years later. I mean you go peeling all the enamel off the teeth ten, twenty years later, I don't care what any cosmetic guru tells you, the reality is those teeth are going to need retreatment. When it goes to retreatment, it might need a crown. Some of those crowns might turn into endo. Then ten, twenty years later, some of those PFM crown root canals fail. They need to extract it. Now, you're looking to implant or crown. The best treatment in dentistry is no treatment. I always see dentist - someone will come in and say, "Well, I want veneers." and they'll do them. But when it's his daughter, it's like, "No, you're going to get braces and you're getting bleaching and bonding." It's so conservative. 


I think the millennials are going to be the most conservative group there is. I mean older people... like look at the Ten Commandments, the first three authorities. Only one God. Don't take his name in vain. Worship on Sunday. Then the fourth one is honor your father and mother. Well, millennials are like, "Well, I’m not going to honor my father if he’s a piece of crap. What if he was abusive?" So they're more spiritual and they're more loyal to themselves. But the baby boomers, the doctor said, "You need this." "Okay. Well, you're the doctor." The millennials are starting to do a Google search, and they're going to want massively minimally invasive. I think veneers, indirect porcelain veneers, reached its peak five years ago. It's swinging back to Invisalign, bleaching, bonding. That's what I would want on my kids 


Olivia: Especially if you have the room to do something more additive, so you just have to just roughen up the surface. You don't have to take away a lot. Yeah, I agree. I know myself I'm pretty conservative so far. I think that might be a third year dental student trait. Touch the tooth with the drill and, “I'm done, right?”


Howard: Say the veneers like Lumineers where you just add them. So many older, non-attractive, fifty-, sixty-, seventy-year old male does all of [inaudible 0:09:05] the tooth. But if you'll be objective and you look at women, there's nothing about it natural. The red lipstick, you don't see someone with a red lipstick and you say, "Wow. You have amazing cardiovascular circulation. Your lips look - I can almost see your red blood cells." Their hair, mascara, eyeliner, make-up. 


When you're adding a little millimeter on there, they don't care. Look at breast augmentation. Most of them look like clowns. Fingernails, fake fingernails. When you see someone with half inch long veneer, you don't say, "Wow. Do you like eat calcium and phosphates all day long or you have a diet on milk and cheese?" I don't get that unnatural stuff. But that's cool that you have a passion. You have a passion for cosmetic dentistry? 


Olivia: I was starting to. I was really intimidated by it at first. So that's something I've become more passionate about that I'm surprised about. But I do like surgical things as much as I expected. 


Howard: So you like blood and guts.


Olivia: Yes.


Howard: That's my favorite. Blood and guts. Well, if you're going to do cosmetic, you want to learn Invisalign. Indirect clear aligner is really taking the ortho market by storm. Will you be able to do the Invisalign in school? 


Olivia: Yeah. I have somebody in a case right now. They're actually doing this for cosmetic purposes. They have an edge-to-edge bite. So they're flaring in the lowers and flaring out the uppers to try to get room for some porcelain veneers. 


Howard: It's funny. I've seen so many people over the years. This is thirty years ago where they used to do a lot of four bicuspid extraction. Thirty years ago, it's maybe half and half. Now, thirty years later, it's about 25% in three quarters. But some of those guys, I'd say, "Why are you doing that?" They'd go, "Because it's the only way I may be able to nail the midline." 


Three times with an orthodontist that I was working with, I'd say, the first one is his wife. I said, "Don't look at your wife. Is her midline straight up or is it off to the left or to the right?" He didn't even know. I'm saying, "Hey, you have three kids with this lady and you don't know where her midline is." Then another orthodontist told me, "Oh no, you got to hit the midline." He's saying all this. I said, "How long have you been his assistant?" She goes, "Twelve years." I said, "Is her midline on or off?" No idea. So the midline stuff is the same. Just in the beauty. What about you? Do you like cosmetics? 


Taylor: I'm starting to get into it. Pretty much right now, I think my big thing I'm working on is treatment planning with my patients. I have a lot of new patients that come in [inaudible 0:11:42] right now and trying to work on just what's the best options for them within the next couple months or a long-term plan too. When I've gone to dental school, I didn't think I was going to like removable that much like with RPDs or complete dentures. I feel like I've got a lot of experience with that in my first eight months with this. I'm trying to see what the best options are for a lot of removable options too. 


Howard: Well, that's one of my gripes about dental conventions. They always have the All on 4. The reality is there's two hundred eleven thousand Americans who have an active license to practice dentistry. A hundred fifty thousand are thirty-two hours a week or more. General dentists, thirty two thousand, are thirty-two hours a week or more especially. They were talking about All on 4.


The bottom line is 95% of all the general dentists in the world are never going to do All on 4. For every All on 4 lecture they went to, they're going to do a dozen all on nones. The all on none market is ginormous and the All on four is 25,000 an arch. That's 50,000 bucks. Now, I mean there's not many people who have 50,000 bucks. In fact, ClearChoice, the big implant center, ClearChoice, they're the largest deal. They're doing about seventeen thousand arches a year in a country of three twenty-five million. 


Yeah. So it's 0.00005 point, four zeros and then a five. You go to these classes and there would be prosthodontics. 96% of all the crowns sent to Glidewell are one unit at a time. 96% of all the courses on crown and bridge or full mouth rehab. While they're doing all this stuff, he said, "Raise your hand if you haven't done a full mouth rehab this year." All hands go up.


What I want to say about what you're doing in a treatment plan presentation that is so important because what we see is in America 38% of the diagnosed x-rays are drilled, filled, and billed. They're collecting $750,000, taking home about one $175,000, having three patients come in with a cavity and they drill, fill, and bill one. 


One of the three is never going to do anything right. I mean they come to my office on an oxygen container smoking in the parking lot. I mean people are people. People who master treatment plan presentation, they get that middle guy. Instead of doing $750,000, they're doing $1,300,000. Instead of taking home $175,000, they're taking home $350,000. 


My four boys and I got four grandkids, two walk and then two in the oven. I wouldn't want them to go. I mean if you have two dentists I thought you got two out of three chances to get my granddaughter to fix her filling. If you had one out of three chances, I'd say she was a better doctor. That's the only really good thing about all this fancy technology. You don't need any of it to do quality dentistry. I mean every implantologist is going to sunk ten thousand implants, did five thousand of them with a two dimensional PAN or CBCT. They were fine and perfect. The one advantage of that fancy technology is in presenting the treatment to the patient, so they can see on the digital x-rays. They can see the Invisalign cases. All that technology makes them understand what's going on and more likely to buy. So you should just master that.


Taylor: I'm trying to, yeah.


Howard: Treatment planning and presenting. 


Taylor: Yeah. What's hard about the dental school is that we'll have a certain number of patients, and we'll have months until our next opening. So that's another difficult part is telling them, "Hey, I can do all this for you, but I'm not going to see you until April," when it's February 1st. 


Howard: Why is that?


Taylor: Just because of the amount of patients we have at the school. 


Howard: So you don't have enough chairs? 


Taylor: We don't have enough opening. If that patient is with me, it's someone who wanted to be with me. So it's hard to almost say, "Hey, I'll see you in April for our cleaning."


Howard: Is that because between now and April, those two months you -?


Taylor: I'm booked.


Howard: Oh you're already booked. 


Taylor: Yeah. That's not saying that I'm super popular. That's just at the school that's how kind of if they want to be with you as a sole provider, then sometimes they have to wait or if we have a group of four where I have a partner as a third year and I have two fourth year mentors that could possibly take the case also. 


Howard: Is the clinic in general booked out way in advance? 


Taylor: Not as much like that, but it takes longer appointments and longer times to get in. That's the negative about the dental school. We are cheaper, but it is going to be a little bit longer. 


Howard: Well that's the problem. So if you go to the market and you say, "This ballpoint pen is a penny," and you sell all in that day, what's wrong with your price? It's too low. If I go to the market and say, "This pen is $100," and no one buys it, what's wrong with my price?


Taylor: It's too high.


Howard: It's called line queueing theory. Lots of PhDs wrote massive interesting papers on line queuing theory. The way you gauge your line is with price. You're leaving too much money on the table by pricing it too low and having a one-month line. If you raise the price, some people are going to get out of line. So you'll be tracking more money per hour so that you can buy technology upgrades and all that.


Other things in line queueing theory like McDonald's does it wrong. I don't know why they haven't figured it out. When you go to McDonald's, there are six lines You get in your line and then the other one is moving faster. Everybody's stressed because they think they're in the wrong line. So you have one line and then the next available teller like at a bank or Wendy's, the next available teller will help you. Then everybody thinks it's fair so that they don't think of negativity and they're looking around or Facebooking or whatever. So you need to go to your dean and tell him that this short, fat, bald guy in Ahwatukee with an MBA from ASU says these prices are too low. 


Taylor: Yeah, it's a difficult thing. I get why we do it too is because we are new students. So we need to get better practice, and it takes longer for appointments. But we are working out at the school and seeing how we can make it more efficient with that.


Howard: Well just raise the price because it's not fair to the person in line. So if the guy in front of me in line says, "I'll like pay $50 for a filling. So now I got to wait in line for two months." The guy behind him, I say, "Should I pay $60 if I had it done today?" So it's not fair for the guy in line to be holding up people who would pay more to get to the front of the line. So, what else got you passionate? So tell me about blood and guts. What's got you passionate about blood and guts?


Olivia: I've just always really liked blood and guts. They used to actually full surgeries on TV on Learning Channel, and I grew up watching that stuff. I just always like to ask, like six and seven, asking my mom, "Can you put on the surgery?" I like that stuff as much as I always thought I would. It's interesting. It's amazing the stuff you can do. I also like having to know the anatomy. You have to realize that there's a sinus up there when you're extracting maxillary molars. It just makes me feel like more doctorly, I guess. I like that.


Howard: Business in three words is supply and demand. If you want to gauge supply and demand, look at income. An average general dentist is $175,000 a year. Average oral surgeon is $411,000. Endodontist is like $375,000. When people are in pain or have an impacted wisdom tooth or a tooth broke and they go to the dentist, the blood and guts is where you don't have to be a great treatment plan presenter. I mean you got a wisdom tooth so it needs out. They're asking you to take it out. If they got a toothache, they're asking you to do the root canal or take it out.


It blows my mind how many dentists during the 2008 financial meltdown. I hope we're not right at there again, but I'm fifty five. So I've lived through this rodeo. When I graduated from high school in 1980, I had 21% interest rate, double digit inflation, unemployment. It was horrible. Then I got out in 1987 in May. Then October of 1987 is Black Monday. That was horrible. Then, of course, the internet bubble from 1993 to March of 2000 pop, and NASDAQ went like fifteen hundred to eighteen hundred. That was horrible. 


Then we just had the last one. I looked it up. The last one over ten years ago was my fourth recession rodeo that I rode. About eighty-five dentists factually - no, I think it was eighty actually went bankrupt in the valley here. Two or three of them are in my room crying. It was a mess.


But it was so amazing how a lot of them they were up in Scottsdale doing cosmetic surgeries. All they would do is you would come in. They'd take out all your PFMs and amalgams and put on fountains and amalgams and put on Empress glass ceramic all that stuff and charging the bank. Then when that market completely died, they couldn't do an extraction. They couldn't do a root canal. They couldn't do a denture. They couldn't do a partial. I always thought that was weird because imagine if you broke your leg and the ambulance took you to the hospital and the emergency room said, "Oh we don't do legs. We just do arms and ears." It's like, "Dude, you're a doctor." I think having all those tools in your toolbox is well rounded. 


Olivia: Yeah, I agree. The goal is to just soak up as much as I can during school and hopefully to be able to do it all in my office one day. 


Howard: Well, I think you will. Most people will do whatever they fall in love with, and where that's confusing is that something's really hard and beat you up. Then you know it's a great dopamine and oxytocin and serotonin and adrenaline and norepinephrine and fight or flight, and you say you hate that. Well, of course, you're going to hate something that's really hard and beat you up.


I remember my boys. I started them on wrestling when they were five. That was my sport in high school. I remember they were five years old. They didn't like it. I mean you go out there and get your butt kicked by someone because they just started. But after a year round for two or three years, then they were on the other side of that coin. Tell your classmates when they tell you they hate something, say, "Well, give it a hundred units. Give it two hundred units. By the time you did a thousand, you're really good. By the time you did ten thousand, you've mastered it." What clinical stuff do you like? 


Taylor: We have an advanced care clinic in our school.


Howard: You have what?


Taylor: Advanced care clinic. It's like a special needs department over there. We have a couple of rotations over there where we see special needs patients. So that's one of my great interests before I went to dental school. Getting that experience and working with those types of patients has been challenging, but yet it's been rewarding in the sense that I could practice what I've been learning in school to actually do it on a patient like that. 


Again, using the basics of treatment planning and also doing cosmetics over there too or just getting them out of pain has been a good experience thus far. Also, there's an AEGD clinic over there, and we get to work with the residents also.


Howard: AGD.


Taylor: AEGD.


Howard: Oh AEGD.


Taylor: Yeah. AEGD.


Howard: What does that stand for? 


Taylor: Advanced Education General Dentistry.


Howard: That's residency. 


Taylor: Yeah. One-year residency over there. We have two residencies. One's an orthodontic residency and one's an AEGD. 


Howard: So with orthodontic residency, does the school pay them or do they pay the school to go to ortho? 


Taylor: They pay the school to go there. 


Howard: What about the AEGD? 


Taylor: I don't know for sure if they pay to go there or if they get paid to do that. 


Howard: Where do you think your interest from special needs come from? 


Taylor: I have two brothers who have autism. I'm the oldest of five. Two of my brothers have autism. 


Howard: Wow. What kind of autism?


Taylor: My brother, Marshall, he's twenty-five. He's a bit higher on the spectrum. My brother, Gabriel, is 21. He's a little bit lower. They're misdiagnosed when they were kids up until my brother, Marshall, got into high school. So they were misdiagnosed with ADHD and dyslexia learning disabilities. But one of their biggest challenges was going to the dentist. So that's where it kind of sparked my interest with it. It's been a good experience at ASDOH because I get a lot of patients who have similar experiences in the past. So I guess I'd be doing that now. 


Howard: That is so cool. I got five sisters, two older and three younger. The one just younger than me, special needs, and was tapped as Asperger's syndrome. Is there any medications for that? 


Taylor: There used to be. I think it's more of just they're working right now. They have this with my family right now. It's more of just everyday life just living their life and trying to get through with that, and they're doing an excellent job.


Howard: That's awesome.


Taylor: Yeah. They live in Albuquerque. Currently, they're working and they have programs they go to throughout the week. My brother Gabriel does. My brother, Marshall, doesn't. My brother, Gabriel, does and they get help. Everything's normal to me. 


Howard: One of my best friends here in town, he runs a special needs center for trisomy 21.


Taylor: Down syndrome.


Olivia: Down syndrome.


Howard: Down syndrome. It's funny because when I go there and have lunch, he thinks it's so funny how a lot of people feel sorry for these kids with Down syndrome. But this is an adult place. He says, "My god, they're 40 years old. They don't have a stress in their life." A lot of times we'll be talking. One time, me and Mike were talking, and a man came in with Down syndrome. He goes, "We were supposed to have Graham crackers and frosting ten minutes ago." Mike said, "Oh my God, I'm sorry." So he jumps out. We make them for everybody. Mike said, "How would you love it if the biggest stress in your day was that your Graham crackers and frosting was ten minutes late?"


Howard: My sister, Caitlin, she's one of the happiest people I know. So overthinking gets you in a lot of stress. Are you thinking about doing a residency in special needs or is that more the specialty, pediatric dentistry? 


Taylor: There is some kind of residencies that specifically do a lot of special needs, but I'm uncertain right now where I want to do with residency. I'm content with where I'm at, but we'll see. We'll see where life takes me after my third year and exploring those residency options for that because I've gotten a lot of experience at ASDOH with that.


Howard: So you were born in Phoenix. 


Taylor: I was born in Phoenix, grew up in Albuquerque.


Howard: Grew up in Albuquerque and then you're in a dental school. So lived in both towns. How do compare Phoenix to Albuquerque? They're only an hour flight away.


Taylor: Yeah, forty-five-minute flight. I love it here in the Valley.


Howard: Do you love it more than Albuquerque?


Taylor: Yeah.


Howard: How was the two cities different? Because you know what's the weirdest thing if you look on a chart? At the end of the World War II, Phoenix, Albuquerque, and Denver, three war to finish our green number three pairs of the same size, and they all went different directions really. 


Taylor: Yeah. I think the opportunities here are tremendous compared to Albuquerque even with work other than dentistry. I live in Gilbert. Driving fifteen minutes down the road, I have everything I need. In Albuquerque, it's ten years behind on everything. I feel like there's not enough money in the state to go around to other opportunities. Like my brother's Special Olympics in Mexico got cancelled this year due to the budget. It was kind of sad to think about, and even programs are falling apart. So it's sad to see in Albuquerque, but my family likes it there. My dad grew up there. He's from there. So they like it there. But I found my home here, and they come visit me all the time, and I go back sometimes too. 


Howard: I don't like to talk about four subjects; politics, religion, sex, or violence. But in MBA school when they talk about macro-economics and politics, they show all the things that New Mexico was anti-growth. I mean people would say, "We want to come in and do all that." It was like, "No, we don't want to do that." Really, everything in ten, twenty, thirty years of anti-growth policies ended up making a huge difference. 


Taylor: Yeah like we got excited when Jack in the Box got created there and that was back in like 2005. I was like, "Jack in the Box is awesome." and this is. Albuquerque is just seven hundred fifty thousand people. Just little things like that kind of just add up. 


Howard: But it's got better elk hunting than Arizona. 


Taylor: I bet. My wife's family hunts, but I don't. 


Howard: I don't. I refuse to kill anything that I don't want to eat. I have no problem shooting cows. I can shoot cows with machine guns, a fish. But elk and deer, I just don't like the taste of it. My oldest son loves the taste of it, loves to hunt it, eats all damn thing. The trick is what they do is they go to the Bureau of Land Management, and they see where they got their tags are. They find the biggest area of land with the least amount of water because those deer and wild horses, they got to drink water every day. The ideal is the biggest piece of land with only one pond, and you know they're going to be there at sunrise and sunset. No questions. What's your next move? What are you going to do? 


Olivia: I'm not quite sure yet, but I think I'm set on staying a general dentist and probably not doing a residency. I'd like to start looking at job opportunities. I think ideally for me I'd like to see a slower private practice setting with the mentorship. I think I'd like to experience something faster paced maybe lower cost like get people in and get people out. I want to see as much different sides of practice as I can, and I'd like to own my own practice maybe five years out. 


Howard: Why five years out? 


Olivia: I want to get some experience. I want to feel really confident with the dentistry. I want to see a few different business models, get more experience with insurances. That's relative, the five years, but I think that's going to be enough time without waiting too long. That's kind of what I have in mind. 


Howard: Let me run a few things with that. A lot of new things you can use in five years. So we know the turnover in associates is just one to two years. They don't stay anywhere and it's not just dentistry. I've repeated this too many times. Everybody's focused on the fact that like my mom's brother got a job at Mobil Oil when he was sixteen and retired at sixty-five. That was so normative in Japan and the baby boomers.


But when you take the biggest market cap companies have Facebook, Apple, Amazon, Netflix, Microsoft, I mean their employee only stays one or two years. The only reason I'm telling you that is because if all the people that graduated in the last ten years went to Heartland and Pacific and Aspen or went back home to their hometown dentists and worked there five years, I'd say that's a great plan. But I'm just telling you that all your homeys quit after a year or two because humans don't like checks and balances. They don't like being told what to do. They don't like to be under your thumb. If you're going to wait five years to set up your practice, I bet you you'll have between two and three jobs. 


Olivia: Yeah. I also do have a potential job offer that would be starting out part time. Somebody I used to work for as an assistant, he said that we could kind of grow the practice together and eventually that could move to a five-day-a-week thing. He just doesn't have the patient base yet to promise five days a week off the bat. So that could work out doing corporate thing for a couple years and moving into that direction, but we'll see. That's still in the very early stages of talking. 


Howard: One of the things to tell all your homeys about is on Dentaltown we put a lot of work and effort into it. We programmed a free classified ads. The categories are seeking employment. You're looking for a deal or looking for an associate job available. Look at that. Two thousand six hundred and seventy jobs available. Then you can search by state or city. 


The DSOs love it. A lot of the DSOs that I have talked to, they said, "My God, we find 80% of our people on your free classified ads." What we do is imitation is the sincerest form of flattery. We looked at all the other job sites, the big ones, Monster jobs, all the big ones. We took all their features. You can put a picture on a resume. The other thing that's really good is a lot of students like, say, you're in Arizona but let's say your wife wants to live in Florida where her mom lives. Well, the internet doesn't know any borders. Buying new practice, selling practice, that's a good mentorship too is when you go buy a practice. Go work for someone for a year and then buy it. It's all free. You could find a job. 20 


With twenty six hundred and seventy jobs, I guarantee you wouldn't have to reply to fifty of them before you'd already have a job, I mean, if you reply to all two thousand six hundred seventy deals. You're passionate about special needs, but were you in the Arizona Student Dental Association because you had me come in two Sundays ago?


Taylor: Yeah two Saturdays ago.


Howard: Oh two Saturdays ago?


Taylor: Yeah.


Howard: Thank you for that. That was so damn fun.


Taylor: No problem. Thanks for coming. That was all fun.


Howard: So what was that about? What were you involved in that brought me in?


Taylor: Actually, Olivia and I were presidents of the American Student Dental Association for each school as a chapter. She just got finished actually being the president.


Howard: You were both president at the same time?


Taylor: I'm at ASDOH. She's at Midwestern. So we're both. 


Howard: Oh you're a Midwestern.


Olivia: Yeah.


Howard: Oh okay. I miss that. So you were both president of the American Student Dental Association.


Taylor: For our schools, yes. There's sixty-six chapters across the country. We represent for each school, yeah.


Howard: Were you the president for the whole school or for your class? 


Olivia: For the whole school. I just finished up my term about a month ago. So I found a lot more free time on my hands, and you'll be there soon. 


Howard: First of all, volunteerism is amazing. They say only 14% of adults volunteer whether it's Kiwanis, Rotary, the church, food pantries. Only 14%. What was inside of you that made you lead that 14%? Why did you want to be the president at Midwestern of the American Student Dental Association? 


Olivia: For me, it took me a long time to get into dental school. I figured out I wanted to be a dentist about halfway through college or in the start of my third year. So I didn't have all the perfect grades. I didn't have all that. So I applied, got rejected, did a postbac program. Once I finally made it, I just decided that I wanted to get the very most out of it, and leadership helped me get to know the faculty better. It just gave me some opportunities that I wouldn't have had if I wasn't doing those things. Also because I want to be a practice owner kind of being in charge of some people and trying to manage more things at once, I think that was a good experience for the future. 


Taylor: It kind of just fell into my lap doing it. I did ASDOH before dental school. So I kind of had a mentor at ASDOH, and she kind of introduced me to it. Going into dental school, I just knew I want to be part of it just because they were doing the most to better my education at dental school outside of just the classroom and the clinic. I kind of just fell into it during my third year just representing my classmates. I wanted to be more involved in the university too, and I felt like it was a great thing to be a part of and get experience such as this right now. I probably wouldn't have had this opportunity if it wasn't for ASDA. Yeah, volunteering is just it doesn't feel like it's a job. It's training, draining, but I just feel like it's part of dental school. I feel like what I have to do. 


Howard: Is it an elected position? 


Taylor: Yes, it is, yeah. I ran unopposed, so I guess it was a little bit elected. 


Howard: Yourself probably repelled a lot of competition like someone else would run. There might have been five guys running. I think that's really, really cool. I don't want to get politically incorrect, but we have two dental schools in the same valley. They're not in Phoenix. You're in Glendale and you're in Mesa. One is the west side of Phoenix. One is the east side of Phoenix. Is the school a school of school or are they different? Are they fundamentally different or is it dental? Because there's some kid who's listened to this and said, "Well, I don't know which dental school to go to." What would you tell a kid born in Ahwatukee? Are they the same? Are they different? Does it matter? 


Taylor: I think they're different. Honestly, I think it really doesn't matter. I think it's good to be different. I went to undergrad at ASU. So I have both opportunities to go visit Midwestern and ASDOH. I felt like they both have their positives. I think the differences are just it could be what I was told when I was before dental school was that Midwestern is a great place to be a general dentist. You have new facilities there. You have great patients. You have great faculty. What else am I missing with Midwestern? 


Olivia: What I get told a lot is that the great clinical experience, and I don't know how it compares to ASDOH. I never interviewed them. So that's just what I hear, but I'm sure it's great. You can be a great dentist graduating from either program. I think it's going to depend on what you're looking for out of a school. Midwestern doesn't have the public health or as much special needs experience. So if that's what you're looking for, ASDOH is a good choice. 


Taylor: I kind of chose that for the public health reason like I'm getting my MPH there, and I felt like that was a good opportunity to get my degree there. So I like rivals like ASU versus U of A. As a pre-dental student, I wanted to just get in dental school. It wasn't to be too snobby, but I don't want to go to UCLA over ASDOH. That's how I chose my school. I felt like ASDOH gave me the right opportunity and I just took it. 


Howard: After you got your degree from ASU, did you get a degree from U of A?


Taylor: No way.


Howard: Because to get a U of A degree, all you got to do is drive by the university real slow with your windows down. They'll just throw it out there. They're completely useless. They're worthless. What made you want to get your master's in public health that much more work? Isn't it six core classes and then six electives? 


Taylor: Yeah. I think it's seven core classes at ASDOH. We do get our certificate.


Howard: Seven cores and then how many electives?


Taylor: I think there's another five to seven, I believe, yeah. 


Howard: I mean that's a lot of work on top of getting a dental degree.


Taylor: So it's online. 


Howard: Why did you do that? 


Taylor: I do want to get into public health later on, I believe, whether it’s in a community health clinic or something of that sort. I felt like it was an opportunity I couldn't pass up on. I feel like during my third and fourth year I can manage doing stuff online because it's all online. I do a practicum during my fourth year. I could take time off the clinic to do that, but some of the classmates that I've talked to didn't need to take time off to clinic. 


Howard: When you say public health, what does that mean to someone? 


Taylor: Public health, so in regards to the community health center to cheaper dental care that could be over in a different part of the state. Access to care can be an issue for this community. Having a community health center there could provide cheaper dental care, better opportunity for them to receive care. Working in a public health setting such as that where it's needed the access to care has been an experience that we would get here at my dental school. During our fourth year, we get rotation sites. So half the time during my fourth year, I'm in the clinic. Half the time, I'm on an external site, a community health center across the country. 


Howard: It's tough for international viewers. So basically in the United States, Medicare is a federal program out of Washington DC that's for the older people and then Medicaid is for the poor. But each one of the fifty states has it differently. Lots of states don't even have money for community health center. Now, we're in Arizona where there's a lot of Indian reservations. The Bureau of Indian Affairs has a lot of deals. When you say these community clinics, are these mostly Indian reservations or do some states have more Medicaid-sponsored community health centers for people who are poor? 


Taylor: Yeah. Even here in Phoenix, there are some areas where there could be a community health center. Like you said, the Indian reservations do have those. For example, I'm going to San Carlos, which is about an hour and forty-five minutes away from here from Ahwatukee to do one of my rotations.


Howard: San Carlos? 


Taylor: San Carlos, Apache, yes.


Howard: So it's up north? 


Taylor: It's east. It's by Globe.


Howard: Oh it's by Globe.



Taylor: Globe and Miami, yeah.


Howard: Nice. When you leave here at one hour, you're at Superior?


Taylor: Superior, yeah.


Howard: Then 30 more minutes Globe?


Taylor: Mm-hmm.


Howard: Superior, have you ever done that Arboretum Walk? It's a mile circle walk. It's the coolest thing in the world. They have plants from every continent. It is so damn cool. Whenever you're at Globe, you guys got to stop there and get out, stretch, and walk around. It's just crazy, crazy good.


Taylor: Let me check that out. 


Howard: Do you see yourself more in working for an Indian reservation or more of a Medicaid clinic? 


Taylor: Probably in the future down the line, twenty, thirty years probably in Medicaid closer to that. Right after dental school, I don't know what kind of office I want to be in if it's private practice or community health clinic like that. I want to keep my options open with that. Eventually down the line, I would like to do that. 


Howard: I hope that you also do your online and your MBA. I don't want to get political, but a lot of economic principles... economics is as much of a science as endodontics. I think they're both about the same predictability. I mean what we know with endos that in five years 5% of the molars treated with endo or extracted if the endodontists did them, and 10% are extracted if general dentists did them. 


We're talking about a 5% to 10% failure rate in just sixty months and that's insurance data. I don't like data were three people looking at PA and you're saying, "Was that failed? Is that failed? Is that failed? We're talking about simple black and white. It was extracted and paid for by an insurance company. 


Like you go to this Medicaid plan, when you start treating the poor or our taxes, it gets so emotional. When you're at ASU MBA, it's not math and geometry are emotional. No one gets mad that an integral and a derivative are different. It just is what it is. In these Medicaid clinics, they have a 50% cancellation rate because the people that are sponsoring them just believe it has to be free, but that's not how you manage people. They went to Taco Bell and spent 5 bucks. If they had to open up their purse or wallet and pay $5 to make an appointment, that cancellation rate would go from 50% to 5%.


Then when you tell people like in that arena, well, they got to pay $5, they get mad because like they're already poor. It's like it's not about poor or rich. It's how do you manage people. I think you were talking about different business models, treat them faster and all of economics, all they do is every year they measure everything and they try to do everything faster, easier, higher quality, and lower cost. 


There's only two industries that don't apply business or economics. It's the entire government and the entire healthcare system. I mean even little things like you go get in a car wreck. The police, they're not digital. I think that would be, my gosh, it would be so cool if we got the president of the United States instead... I mean one guy said, "We're going to go to the moon and back. We're going to safely put a man on the moon and return him in ten years. You know what would be far cooler than that? We're going to be paperless in ten years.


I mean like 911. You call 911 and they're like, "Well, you can give me a description of your car?" Dude, I can Facetime my eighty-year-old mother. How come I can't text 911? How come I can't Facetime you? You know what I mean? They just are not technical. So bringing technology and economics to public health would just be huge, just huge. A few business principles, a few technology principles, that'd be amazing.


I also wish you guys could help spread the word to the American Student Dental Association that you're doing your whole MPH online. We have four hundred online course on Dentaltown, and they're all free to dental students. That is just amazing. I feel so proud of that. Does A.T. Still have an online? What other online programs they have besides master's in public health? What else could you choose from? 


Taylor: They have different programs at A.T. Still. We have PTs there, OTs, and there's different other health specialties.


Howard: PTs, physical therapists.


Taylor: Athletic training. We have a DO program in our med school, audiology program, and athletic training and some PA.


Howard: Physician's assistant.


Taylor: Yeah. My wife is a PA actually. So it's good to have somebody else -


Howard: She's a physician's assistant?


Taylor: Physician's assistant, yeah.


Howard: Where did she go to undergrad? 


Taylor: She went to ASU. 


Howard: So you meet her at ASU?


Taylor: Yeah, we met at ASU.


Howard: So she went to four years of ASU?


Taylor: She actually did three and a half, I think, and then went to two years at Pacific University in Oregon


Howard: Pacific in Oregon. 


Taylor: Yeah.


Howard: That is now coming to dentistry.


Taylor: Similar model they're trying to do with therapy.


Howard: Yeah and the dentists, of course, they get so emotional and they are so upset. By the time you're fifty-five, you see these rodeos so many times. The first time you're all involved and then you're all riled up. The second time you're like half. Then the third time you're like, "Dude, it is what it is." It's funny how is the glass half full or half empty.


The initial rodeo was like back in the fifties when we started training girls to do cleanings, and the dentist will say, "Well, no, that's my job," It's always territorial, turf-protecting, and they're like, "No, no, that's my job, and she's going to take food out of my mouth." It's always protection.


There's not a dentist in America who wants to fire his hygienist and do all of those cleanings. Then you look at these physical therapists or dental therapists or whatever. So when I am in a state that has hundred of them practicing, half of them are just outraged and want to fight in the laws and the courts. "We should take it up to the Supreme Court." The other half are like, "God, man, this is awesome. My hygienist is doing my cleanings. My dental therapists did all my simple routine fillings."


I saw one dentist. It's not about treating people faster. He would sit there and he worked for chairs for just restorative. Then he had a big case over here that was scheduled like an hour-and-a-half or two-hour appointment. He would numb, numb, numb, numb, and then go work on this big case. Numb, numb, numb, numb and then he'd go back to first drill, drill, drill, drill, and then leave. Then they would sit there and pack it and clean it and all that stuff. That was with expanded function of dental assistants.


Now with the dental therapists, he didn't even have to numb. He didn't even have to drill. So the hygienists are doing all the cleanings. The dental therapists are doing all of the fillings. So he can concentrate on the stuff that he feels that he went to eight years of school for, the hard stuff, maybe it's molar endo, implant, surgery, special needs patient, takes more time, or whatever. 


The other deal is regardless of whether you want it or not, it doesn't matter. When you're your age, you think you can stop it. You know what I mean? When you're my age, it's like, "Look, this happened in medicine, and it's not going back." It's just mid-level. It helps with accessibility, availability. I don't even go to the emergency room anymore. Gosh, darn Walgreens is right up the street. He's got a 24-hour, seven-day-a-week Walgreen's Clinic. They got the little med clinic in there. If it's something serious, she would tell me. One time, she sent me to the hospital. She said, "Dude, that's a kidney stone." Yeah, you got a flu. Take this. Do that. Just availability, access, affordability, that's where the market will go.


Taylor: What are you passionate right now about dentistry?

Howard: What I'm passionate about the most is after doing it for three decades, I'm a dentist and I'm from UMKC, and I got MBA from Arizona State University. What I see the biggest problem in healthcare is availability, affordability, accessibility. So I like studying the business models, and I like transferring knowledge.


Dentaltown started in 1998 when I saw them talking about football on the ESPN website. I said, "We need to be talking about dentistry." Dentaltown was just enormous and the motto was, "You will never have to practice solo again." Dentists were professionally lonely. They were isolated. To be able to log on and talk to your fellow colleagues about a case or whatever, there's very few people who knows what it's like to own a dental office. You got your staff all wanted a raise, your insurance not wanting to cover anything, the patient thinks everything should be for free. It's crazy. You got to do all that while you master root canals, fillings. It's an overwhelming deal.


When I got out of school, the first ten years I got my fellowship in AGD, my mastership in AGD, and my diplomate at International Congress of Oral Implantologists. I mean it was a solid about 300 hours of continuing education. I was mastering my craft. Then after that, the second ten years is more about, man, I wanted to learn about this endo thing, but the course to the Arizona State Dental Association is up for six months. I don't even know if they're going to have a course on endo. Then maybe I want to learn about apicoectomies. This guy, I went to the whole eight-hour lecture, he didn't even talk about apicoectomies or whatever. When the internet took off, I thought, "This is a fast way to share information. Like University of Phoenix Online. we started online CE.


Within a country within America, you're transferring knowledge from specialists who have done ten thousand root canals, make an online course. We got a nineteen-hour online CE course in endo that took five years and a million dollars to create. I mean that's talk about a transfer. You can talk about some I don't want to them [inaudible 0:52:36] they'll hear this. Some guy who's done ten thousand root canals trying to teach you - how many root canals have you done? 


Olivia: I actually have not done any yet, which is the one thing I haven't done. That's a whole other story because I'm working on getting a few cases transferred over to me. 


Howard: Watch that course first. How many have you done? This is what just makes me so excited. So here's a guy who's done ten thousand. It takes five years of filming and editing and movie producing. This is like making the movie, "Titanic." Million dollars of video recording, editing, the whole nine yards to just make it as succinct. Where was the book I wrote?


The first draft of this book was six hundred pages. Second draft was four hundred pages, but I knew you got to get it down to two hundred. The first cut of this endo course was thousands of hours, and five years later it's down to nineteen hours. That's the fastest, highest quality graphic video, everything, to transfer everything in his walnut brain into yours and what really makes me excited.


So that's within a country, but you have two hundred and twenty countries and twenty countries are rich and famous and do like the United States. There's United States, Canada, Australia, New Zealand, Scandinavia, Western Europe, Japan, Hong Kong, North and South Korea. But there's a lot of countries that are hurting in the Central and South America, Africa, most of Asia. In those countries, we don't charge a fee for this.


I was lecturing in Tanzania. I've been in Somalia, Ethiopia, South Africa, Soweto. These dentists when they've gotten with me, they actually cry. I mean they just come up to me [inaudible 0:54:32] and they go, "My gosh, my whole village sent me to the best school in Somalia on the harbor." I forgot what it was called [inaudible 0:54:40] or something. "And I came back and I was practicing, and I thought I was the bomb. And then on my Samsung one day, I just happened on a search found Dentaltown. Then I found out that it was free for me." She says, "Oh my God." She goes, "I had no idea. I mean I knew what I knew. I didn't know what I didn't know." She said it would take her three months to save up enough money to fly one way to LA, let alone take the course and go back home. Now, she's listened to all these people, and I mean she just thought it was the greatest thing. 


You got to finish the story over there because back to the free classified ads. I asked her. I said, "If you had one wish in your mind regarding dentistry, your professional career, not your personal life, what would it be?" And she says, "My dream, Allah willing, is that someday I'll have a radiograph, an x ray machine." So I took a selfie with her and I said, "Just post it on Dentaltown." She posted it on Dentaltown.


This is what's so cool about our profession. Three dentists dropshipped their radiograph machine. They go, "Oh I got a new one. No one uses the one in the break room. It's been back there in a box for years." You know, how much it would cost to ship an x-ray machine to Somalia? What would that cost? I mean, good Lord. That's what I love about dentistry. They're all by sharing, helping. I called Dentaltown just a huge AA meeting where you walk there and you go, "Hey, my name is Carl and I've been a dentist for thirty years. God help me." So I'm passionate about that.


Then my new deal, I realized that for twenty years we've had five programmers programming every request you wanted for in Dentaltown. It took me twenty years to realize that all the other social media - I was one of the first guys in social media back when it was 1994 and it was email groups. You'd sign up for a dentist at Yahoo Group Dentist, at Copy Serv Dentist. I think Compu that was the biggest ones as far as like Mike Barr, other guys. You'd open up your email, and it'd just be this endless stuff. Then you'd miss the important email from your mom or your patient or whatever. 


So all the early social media is all they did is got out of your email. So Myspace, Friendster or today what will be Facebook, Twitter, LinkedIn, Pinterest, it's just an endless newsfeed. There's no organization there. That's great for showing here's a picture of me and my wife, my dog and my cat, my birthday. It's great with that. But you learn a root canal in that format, and you can't politically get something done like get a stop sign or a bridge or whatever.


I realized that the message board format, which was one of the earliest formats is dead. It's all endless news feed. So what I did is I cut and pasted on Dentaltown for my town here of Ahwatukee which is eighty-five thousand people. So I call it Tukeetown, and we just launched that. It's so cool because instead of root canals, fillings, and crowns, we're talking about churches and schools and doctors and crime and Facebook news feeds are searchable. So you can go on there and see your kids at Desert Vista High School, and she comes home and says, "My teacher is crazy."


Well, you could go right to the message board categories. You go to schools and then you see there's like two high schools, Desert Vista and Mountain Pointe. You go right to Desert Vista, and then you could go post a thread about your daughter going to Mrs. Cranston. So what if the next reply is, "Well, my kid comes home from school and says that your kid is the crazy one and disrupts the whole class," versus what thirty parents said, "Oh I know. That teacher is out of her mind." 


I look at the endless newsfeed as a mile wide and an inch deep, and I look at organized searchable message board as an inch wide like just dentistry for Dentaltown or just Ahwatukee for Tukeetown. It's just an inch wide, very specific, and a mile deep. 


So what I've done now is I made that community cut and pasteable. Say you came along and say your wife want to do physician's assistant town. So you came along and say your number one hobby is drones. You buy yourself a drone for Christmas. You could do drone town, golf town, swim town. I think the endless news feeds they're just almost like entertainment. They're just mental masturbation. People just go there and scroll and scroll and scroll. They don't get anything done.


We're all doctors and doctor's Latin word, "docere," meaning to teach just like the word Bible. It just means book. I think at the heart of all whether you're a physician, dentist, or doctor of the law or philosophy, I think at the heart is is always a love for teaching. There's always a love for teaching. If you look deep down in the soul of every dentist, physician, lawyer, anybody at ASU that has a PhD, deep down there's a passion for teaching. What I think is the neatest thing about the teaching aspects is the changes in technology, which haven't even started in your school systems yet.


You still got all these kids going into a crowded classroom, and I don't know why all these kids aren't at least what if 20% of the kids stayed home once a day, one day a week, and did it online. You know what I mean? I don't know why every kid has to be bused to that school every single day. I think the technological changes in education whether it be amongst dentists, schools, I just think that's very exciting.


Like I say, when you've done some thirty years, when you're doing your first cleanings, it's really overwhelming and scary and all that stuff. But after you've done a thousand cleanings, you'd gladly give it to your hygienist. When you do your first filling, God help the patient. But after you've done a hundred patients after that, but by the time you've done ten thousand fillings, you'll gladly give it up to a dental therapist or a health therapist or an associate dentist or whatever. 


I think after thirty years I'm most passionate about what's new in this technology and how can we make the next generation learn all the history, learn everything they need to know faster, easier, higher quality, lower costs, just transferring knowledge. Why do you already decided to be a general dentist and not a specialist? What were your thoughts and how did you make that decision? 


Olivia: I think that everything I've done so far I don't want to give up any of it. If I became an endodontist, I would never do another crown or filling or implant uncovering. So far, I actually like it all except for maybe the cleanings. 


Howard: A couple of my friends in dental school, one of them said to me. He goes, "I just cannot learn everything. I'm just going to pick one to make my life easier." So he became an endodontist because he said, "My God, the United States has forty thousand monthly magazines in the healthcare space." I mean that's why the physicians have fifty specialists and we have nine. So the flip side is if you specialize, it's a lot easier to keep up. Because if you do Invisalign, cosmetic with adhesive bondings and all that, and do surgery or place implants. I mean it's a lot. It's a lot to learn. 


Olivia: I might have to make some choices and whittle it down. 


Howard: That's one of the things that by the time you've been out of school five or ten years, a lot of dentists still say to me. They say, "Well, you know, I'm going to add like sleep apnea." I said, "Okay. Well, what are you going to take away?" They go, "Nothing."


So in 1900 there were no specialties and healthcare, was 1% of the GDP. By 2000, the physicians had fifty-eight specialists, the dentists had nine, and healthcare was 14% of GDP. Now, it's 2018 and it's 17% of GDP. So I said, "So you really believe in this Dr. Do-it-all or are we really going to go back to the 1900s where one doctor just does everything? That's out of your mind."


So when you start looking at following these doctors ten, twenty, thirty years, they start off out of the gate trying to do everything. But the ones that get really, really successful and really good, they start narrowing it down. Dentistry is a team. It takes a team to fix the human body. 


Olivia: Definitely. 


Howard: Is every dental student part of the ASDA or they have to pay? 


Taylor: There is a fee with each per year, but our school pays for it. Was that a part of yours too? 


Olivia: If you pay for two years yourself, then our school pays for the other two years. So we both have pretty high percentages of membership. 


Howard: like how high? 


Olivia: I want to say 93%. 


Taylor: Ours is auto enrolled so we have 100%. 


Howard: American Student Dental Association, are they affiliated with the American Dental Association?


Taylor: Yes. This is just a student version of it.


Howard: So this is really part of the ADA?


Taylor: We have partnerships with them.


Howard: Where's your address?


Taylor: North Chicago.


Howard: 211 north Chicago?


Taylor: I believe so, yeah. 


Howard: In the 22-story marble building. Division of ADA. When you're classmates come out of school, what percent of them are joining the American Dental Association? What percentage is transferring from ASDA to ADA? 


Olivia: I'm not sure on that, but we do have an event that we're going to try to promote even more this year where you can convert your ASDA membership when you graduate for the rest of that calendar year to an ADA membership. So I know there is that opportunity to start out. What happens after that I'm not totally sure yet. 


Howard: And then the ugly four thousand pound gorilla in the room, student loans. Are you guys both proud owners of some student loans?


Taylor: Yes, we are.


Howard: What's the mood of the student loan indebtedness in school? What are their thoughts on student loans? Did they talk about it much? 


Olivia: I think that everyone would like for it to be lower. I don't get the sense that anyone is too stressed out about it. Because if you're smart about things and if you're a passionate, good dentist, you're going to be fine. You're not going to be starving. But it's a lot to think about, and I think a lot of us avoid things that could possibly involve hurting our hands like I don't snowboard anymore. 


Howard: You're good on snowboard.


Olivia: Well, I've only been a few times, but after I went the last time and fell and kind of hurt my wrist, I was like, "I think I'll just stop doing stuff like that now." 


Howard: See, I have a broken bone right there.


Olivia: Yeah.


Howard: Can you see it?


Olivia: Yeah.


Howard: I always did wrestling and boxing and still did it when I graduated. I wasn't open six weeks and I broke my hand in the boxing gym. It was so funny because I went into this orthopedic surgeon. He was 60 and he goes, "Hey, dumb ass. You're a dentist. You're not going to fix your car. Throw away your chainsaw. And what the hell were you doing boxing?" He goes, "That's just stupid." So yeah. So did you guys have any dentists in your family tree, mom, dads, uncles? 


Olivia: Not me.


Howard: So you guys are same year. So you guys were all first. What percentage of your class has no student loan debt? Dad and mom paying for loan.


Olivia: Very few.


Taylor: Very few for us too.


Howard: I mean like percent-wise would you guess? 


Taylor: Probably like 5%. 


Howard: Really? So that's really rare. Now what would you say the median average student loan indebtedness would be? 


Taylor: For my university, it's probably about around four hundred. 


Howard: What about yours? 


Olivia: It depends on undergrad loans but probably closer to five hundred for Midwestern. 


Howard: So does Midwestern cost more than A.T. Still? 


Olivia: I think so. 


Taylor: About the same. 


Howard: What's your cost. now these days? 


Olivia: About $100,000 if you're living off of your loans so that's living expenses. 


Howard: So 100,000 dollars, so you'll be $400,000 in debt, and the thing that they don't realize is that last year the average oral surgeon made four hundred and eleven in one year. The average endodontist made three hundred and eighty five. So when you go back to the general dentist, one seventy five, totaling two years' earnings. The general dentists that do what the specialists do, so oral surgeons are making four-eleven, so the general dentists that do their own extraction like my most exciting, fun thing I do is [inaudible 1:07:42]. In fact, my staff has gotten so mad at me because I'm in Phoenix and I'm across [inaudible 1:07:49]reservation. They would come in. If they would fail the financial arrangement but we already had the pan out where we had the drill. I'm just like drilling on these teeth. I'll tell Janice, "I'm doing it, anyway." And she goes, "You can't because [inaudible 0:108:11]. I mean I just love this. 


So the general dentists who do more their oral surgery are making one seventy-five, they’re over the two-hundred, two and a quarter. The same thing if the average endodontist is making three seventy five, the general dentist doing their molars, if they're doing their molars and their wisdom teeth, they're making bank. Then when you start getting in public health, those are what drives those people to the dental office the most. It's pain. It's my jaw’s swollen. I can't eat. I couldn't sleep last night. 


Or children. Pediatric. Pediatric dentists make bank just because all the old guys like me... I mean I had four babies and I got four grandbabies, and the last thing I want is a three-year-old crying. It's just a weird head game. I mean I do it, but I sure as hell don't like it. I mean I'd rather just mow the yard and pick the weeds. I mean it's tough. If you can get into those things, I mean there's a big demand for those procedures. 


Like I say, my biggest joke is you guys are all worried about - are you married?


Olivia: Yes.


Howard: And you're married and you're both married in dental school. Got any kids? 


Taylor: No kids.


Howard: No kids. So you're not LDS.


Taylor: I don't know. 


Howard: You always know when they're LDS because only the LDS has kids in dental school. The funny thing is as crass it sounds but half your class is going to get divorced, and not any of them are going to get divorced for less than $1,000,000. So if you think $400,000 is a lot of money, wait until you get divorced. Did I miss anything on the sum up? I'm so glad that we had two third years come by and share that. I want to tell the older guys looking for associates, I mean, you're always talk about employee turnover in the tech sector because the tech sector it's extremely confusing for the tech sector. 


And even in general dentist's office, there's not - I know it's probably illegal to say this and it's not politically correct. But everyone knows if you hire a forty-year-old associate he'll stay with you probably ten years. If you hire a twenty-five-year-old associate, you're either going to get one or two. But when we look at the DSOs that keep the associates longest, it's actually Heartland and why? Because they have the most CE mentorship and the first thing she said is she wanted to get an associate job as a mentorship.


The reason they left your office in a year is because you gave these two kids all the fillings and single crowns, and you did all the bridges and implants and all that. That isn't how it rolls. I mean if they're not learning, they aint staying. Of all the dentists I know that stayed with an associate for four or five or six years is that, "Well, what kept you in that office five years ago?" And they go, "Man, I knew if I stayed there for five years, and I mean this guy places thirty implants a month or he's done three thousand Invisalign cases. I knew to be at his speed, knowledge, and level and whether it's Invisalign or placing implants or whatever, I wasn't going to learn that working for him for a year.”


So if you want to keep them, you got to mentor them. You got to be making training. If you can't do it yourself, look what Heartland does. They just provide a lot of CE. One thing you could do is provide them online CE. I mean he's getting his MPH online. Pay for four hundred CE courses on Dentaltown. But if they're not learning, millennials are moving on.


Even when they're on Facebook, some guys will say, "Well, what projects are you're working on?" And they'll say, "I'm doing this." And I go, "Is it still fun and exciting? He said, "Well, now, it's just work." Why don't you jump from Facebook over here to Uber and get into the driverless car space" "You know that sounds fun because I'm not learning anything here. I'm just doing repetitive motions. I mean I was learning for six months. I was learning for eight months, but I'm not learning anymore." You're either growing and learning, or you're just working. I don't think anybody wants to work on an assembly line to screw a screw into a hole on every car that goes. You know what I mean? They want a challenge. So listen to them.


Then my final thought for the students is this. It's the human condition to not be transparent. Governments don't want to be transparent, every agency. Nobody wants to be transparent. It's so hard to convince people that nobody cares about you. I mean there's seven and a half billion people. How many of them are thinking about you this morning out of seven and a half billion? 


Olivia: A few. 


Howard: I mean was that 1%. No. Was it 0.00001%. For 20 years, the people that something was not wired right in their head and will just talk out loud on Dentaltown and say, "Okay. So I've got two residencies to choose from and here's the situation with each one [inaudible 1:13:15] and all these older guys. It's like a fraternity. I mean they love their homies, and they're trying to tell you all this stuff that at twenty-five you might not realize that someone might know something more at forty-five, fifty-five, sixty-five, or they're going to buy a practice in their hometown. 


I mean like 99% of dental students won't do it. It's a private matter. They want to ask like one person. Well that's a small sample size. No one in statistics will tell you to sample one person. So these kids that come out of school and say, "Okay, I'm going back to Parsons, Kansas. Here's the two practices that sell." This is like in private messages. Oh my God, the one guy. You know what I mean? He's a horrible dentist. He's been sued three times. He's an alcoholic, whatever, whatever.


So just be transparent. I'd give up privacy so you can make better, faster, easier, higher quality decisions. But it's a Saturday. I think it's amazing that you guys volunteered so much being the president of your schools' ASDA on a Saturday when you could be with your spouses. You came over to my house and taped a podcast so that everyone can learn from you. Thank you so much for coming by.


Olivia: Thank you.


Taylor: Thank you very much. 


Howard: Thank you.




Category: dental student
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