Bill is a 4th year dental student at A.T. Still University’s Missouri School of Dentistry and Oral Health in St. Louis, Missouri and will graduate in May. Bill is a native of the great state of Idaho and graduated with a degree in Exercise Science and Business Management from Brigham Young University. He and his wife, Morgan, are the proud parents of 2 year-old boy/girl twins and are expecting their third child in June.
Bill is a recipient of the Army’s Health Professions Scholarship and, following graduation, will attend Basic Officer Leadership Course in San Antonio for 6 weeks before completing a 1-year AEGD at Joint Base Lewis McChord in Tacoma, Washington.
Bill is passionate about his family, the Utah Jazz, and dentistry. Bill considers it just a HUGE honor to be podcast interviewed by the legend, Howard Farran!
VIDEO - DUwHF #1005 - Bill Frei
AUDIO - DUwHF #1005 - Bill Frei
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Howard: It is just a huge honor for me today to be podcast-interviewing Bill Frei. Thank you so much for stopping by the house. Bill is a fourth year dental student at A.T. Still University Missouri School of Dentistry and Oral Health in St. Louis, Missouri and will graduate in May 19th. Bill is a native of the great state of Idaho and graduated with a degree in Exercise Science and Business Management from Brigham Young University. He and his wife, Morgan, are the proud parents of two-year-old boy/girl twins and are expecting their third child in June. That is amazing. Bill is a recipient of the Army’s Health Professions Scholarship and, following graduation, will attend Basic Officer Leadership Course in San Antonio for six weeks before completing a one-year AEGD at Joint Base Lewis McChord in Tacoma, Washington. Bill is passionate about his family, the Utah Jazz, and dentistry. Bill considers it just a huge honor to come over to my home today and let me podcast-interview him. So Bill, congratulations. You graduate from dental school in a month. Are you excited?
Bill: I'm ecstatic. Yeah, very excited.
Howard: My friends up the street at A.T. Still... I assume you're LDS if you had three kids in dental school.
Bill: You caught me.
Howard: I caught you. My friends from A.T. Still, if they come out of dental school at A.T. Still, married with one, two or three kids, they're usually $400,000 to $500,000 in debt. By having the army scholarship, were you significantly less positioned than that?
Bill: Oh, significantly, yeah. You can get a four-year scholarship which would leave you with no debt because they've paid for all of your school. I paid for my first year of school and then received a three-year scholarship and then because I have a family and there were some medical expenses here and there, we took out a few small loans, but my classmates are graduating with about $480,000 of student debt.
Howard: Is this your average classmate?
Bill: Yeah, and that's not including their undergraduate debt. That's just dental school.
Howard: Wow. Four eighty?
Bill: Four eighty, yup. With the first year and a few loans here and there, I'm about one eighty so much more manageable.
Howard: Your class size is forty-two?
Bill: It's forty-two, yeah. It's a newer school, so I think they had to keep the class size low until they graduated the first class and I've actually got an email a couple weeks ago. They're expanding it starting next year to sixty-two or sixty-one.
Howard: Are how large is A.T. Still here in Mesa?
Bill: I think it's around seventy maybe?
Howard: Seventy? And you know what Midwestern is?
Bill: I don't know what Midwestern is.
Howard: Ryan, do we know what Midwestern's class size in Glendale?
Ryan: One forty-one and seventy-six was ATSU.
Howard: So it's one forty-one?
Bill: Oh is it that high?
Howard: Yeah, big, big, big, big.
Bill: Wow, I thought it must be smaller than that.
Howard: What class were you a graduate of this new school?
Bill: I'm the second class, which was perfect because the first class, they had to work the kinks out and they went through a lot to be honest. I actually have a lot of respect for them because the school hadn't quite figured a lot of things out, they had to put up with a lot of stuff. A lot of those kinks were worked out when we went through, but it was also kind of like they hadn't figured everything out so we're able to get by without doing some things. They kind of tightened things up after our class and said, "You got to take these exams, you've got to…", you know, increase the requirements. I've enjoyed my experience. It's been awesome.
Howard: Well, forty-two, that's intimate. I figured you must be intimate with every person in class.
Bill: Yeah, I know everyone and probably too much about everyone in my classes as well.
Howard: I would rather, rather, rather, rather, rather be in a new school for a second or third class than what I witnessed when I was in dental school, that was when dental schools were contracting and they close down Emory and Georgetown and Northwestern and there were all these people that were freshmen, sophomore, junior, senior, and all of a sudden their school closes.
Bill: There was two schools in St. Louis, Washington University and Saint Louis University, both closed down. There wasn't a school in St. Louis for a long time until our school.
Howard: Yeah, and they were like, "Oh my God, I'm a junior in dental school and I got one year to go and my dental school's gone." They were at the mercy of deans just saying, "Just squeeze into a class and…"
Bill: That'd be crazy.
Howard: That'd be really traumatic. So, I love the variety show nature of Dentistry Uncensored where we've done twenty-five on just endodontists or periodontists or pedodontists or prac- whatever. I'm thirty years down the road than you and I love to hear the other end of the spectrum. I know older dentists listening to the show like to know how- Are you technically a millennial?
Bill: Yeah.
Howard: They love to know how millennials are thinking. what you thought of your dental school, what your plans are. I mean the older guys here thinks everybody in the dental school just wants to work for a DSO, they don't want to own their own business. You are very intimate with forty-two people. How many of those forty-two people, what percent just want to work for Heartland Aspen and do an eight to five at a DSO and have a family, and what percent do you think have the entrepreneur business hat on and want to own their own business?
Bill: Yeah, that's a good question. For my school, I would say for those that want to go into corporate, probably half. Of that remaining half, there's probably about half of those — so 25% total — that are planning on going into community health centers because they offer loan repayment options.
Howard: So, half once to be an employee, and half of that half so a quarter wants to do public health.
Bill: Yeah, public health, community health centers…
Howard: Because of student loan repayment, and the other quarter wants to do DSO?
Bill: I'd say private practice. Private. So, half of the class DSO, corporate, then 25% public health and then the other 25% private practice.
Howard: For the private practice boys and girls, what is the student loan benefit payback into- If this is such an amazing benefit that a quarter of your class went to, what are the terms? Do they just take over your payments while you work for them?
Bill: For DSO?
Howard: No, for public health.
Bill: Oh, public health. It sounds to me like there's different options depending on who you work with, and it's somewhat negotiable as well. So, if you're going into an area of great need, rural Missouri, rural Wisconsin, which is where some of my classmates are going, they can somewhat negotiate as far as what their salary is going to be and then also what that community health center can offer them as far as loan repayment. I don't know honestly a lot of the specific numbers. I just know that it varies.
Howard: What do you think the range is?
Bill: As far as what they're getting offered?
Howard: Yeah, for public health.
Bill: I honestly couldn't even give you a guess because I've never looked into it myself because I just knew it wasn't an option for me.
Howard: If you ever look into that or anything, I think you should post it because there's a lot of guys that are private practice in a rural town of five thousand out in the middle of nowhere — Kansas, North Dakota, South Dakota — and if they started hearing this is the base salary and this is the student loan benefit, a lot of dentists will say, "Got it. That's all it takes. I'll do that." So when you say public health, is it mostly Indian health service or…?
Bill: No, I have one classmate out of the forty-two that's doing Indian health service. She's going back to Oklahoma where she's from.
Howard: Is she Indian?
Bill: She's not, no. Well, I think she actually has some Indian heritage further back, but if you were looking, she's a white female, she doesn't look Indian at all, but her family is from Oklahoma and I think she has some kind of ties with the Indian reservation and someone in her family being Indian. So, she's doing Indian services and then like I said, the other ones are going into either rural Missouri, rural Kansas, Wisconsin to the community health centers around there.
Howard: I'm going to show you a map. I love map porn. I do. I think a lot of things that people argue about and disagree about- I just posted this yesterday. This is a picture- Ryan, would you be able to throw this picture up on the YouTube channel that I'm talking about right now? Here's the map I posted the other day. Here's a map of all the American Indians and Alaskan natives in the United States according to the U.S. Census, and you're talking about she's going to Oklahoma. See how much reservation there is in that area? And then we're out here in Arizona. Arizona, New Mexico, huge. Where did the Europeans land?
Bill: On the East Coast.
Howard: And where are there no Indian reservations?
Bill: On the East Coast.
Howard: Why would that be?
Bill: Because they drove them all out.
Howard: Yeah, when the British and the- The early colonizers were Portuguese and French and the Portuguese went to South America and the Spanish went to central Mexico, where do they speak Spanish obviously and the British went to the United States, Canada, Australia, but they were extremely hard on the indigenous people.
Bill: Oh yeah, I'm sure.
Howard: It was so brutal. They think there were twenty-million American Indians when they got on here and nineteen-million of them died.
Bill: It's insane.
Howard: A lot of people say it was all smallpox. No, it wasn't all smallpox. They drove them off their land and then why are all the reservations west of the Mississippi? Because they thought that there was nothing out there; it had no value.
Bill: Sure, before the Louisiana purchase.
Howard: So they just sent them out there, but this map shows the brutal annihilation of the American Indian.
Bill: Yeah, that's incredible.
Howard: Yeah, crazy, crazy history. But if you can find a range of those offers, I wish you'd post on Dentaltown. I would go under 'Looking for an Associates'. We have fifty columns and under 'Looking for an Associates' because one problem I have with the deans and with Pew Research, is Pew's always saying they've got to do all these things like dental therapists, and the reason I'm against dental therapists, the reason it's not even on my radar is because the problem is even when you're a dentist, you need a hundred hours of continued education a year and it takes five or ten years to get good. So, in my walnut brain, giving a patient someone with even less training is completely the wrong direction, but they always come back with valid points saying there's no people (unclear 00:11:41), and that's because the deans only accept people that they have a four point oh in algebra and trig and geometry. When I asked if that girl's an American Indian, it was Jack Dillenberg who set my mind straight ten years ago here at A.T. Still. He said, "If anybody applies to dental school from the Navajo Indian reservation, I'm accepting him. The Navajos need a Navajo Indian to go back to the reservation. I don't need some guy that got an A in calculus and geometry and trig in Phoenix and then goes and works for Indian Public Health Service for two years then leaves."
So I think Pew is very misguided in the fact that if they have all this money and they have all those natural resources and they're very concerned about all these underserved areas, then you need to go put downward pressures on these US news and world report listings of all the universities bragging about their incoming class GPA and how well they did on DATs that doesn't serve the community well. As extremists as this sounds, I think for the next ten years if every single dental, medical- And it's the same with engineers; when I go to these mines here in Arizona and Utah and I drive some of these mines and I stopped by and I love seeing stuff like that. Me and Eric were looking at a mine where the wheels on these trucks were like the size of a house. I just think that's cool shit. When you talk to those guys, I say, "What is your biggest problem?" and they say the same thing, "You know how hard it is to hire a civil engineer? You know how hard it is to get a mechanical engineer? We're out in the middle of-" If ASU will only accept you to mechanical engineering school if you have perfect scores in math and trig and geometry, but these public schools have accepted, have weighted GPA and not the needs of the rural and the rural pays half the taxes in America. If for the next ten years you only accepted engineers and dentists and physicians and lawyers from towns of five thousand or less, guess what? And then when you go into a lot of these small towns and you say, "Why did they close the factory?" One of the first things they say is I can't attract talent. Do you remember that computer company that looked like a dairy cow? And I was in South Dakota-
Bill: Gateway right?
Howard: Gateway. All of the classical people say the problem with Gateway was that they should have moved to a larger city earlier. They couldn't attract the talent.
Bill: Where were they you say?
Howard: I think they were in South Dakota. By the time they moved to San Diego, Dell had already beat them at their own game. Pizza Hut. I was born in Wichita, Kansas, home of Pizza Hut. For a pizza, it was so hard on him, but he had to move it to Dallas. Again, it's because all the talent is on- These universities are not serving the people-
Bill: I think the schools feel like they're increasing access to care because they're opening more schools, they're accepting more students, but like you said, the type of students that they're bringing in, they're not returning to the rural area, so the market's over-saturated.
Howard: There's no such thing as good food. It's whatever you're sticking in your kid's mouth. So when you go to India, mom's putting a lot of curry in your mouth, not salt and pepper, so you think all those Indian dishes are best. You go to China, all the seafood and squid. You can't raise a kid in Scottsdale and he just grows up in Scottsdale and then say, "Hey, how would you like to live in a town of five thousand?" Because the kid that grows up in a town of five thousand, he got to go out his front door and shoot it a four ten shotgun and ride mini bikes and go carts, and he loves that world and he wants that world for his babies and when he drives through Scottsdale, and he realizes you can't even shoot a gun out in the street, you can't even ride a motorcycle to the gas station. When I grew up in Kansas, we had Honda fifties before sixth grade and we'd go three, four miles down the street and-
Bill: I see that with my own class even, and maybe it is a little bit of the influence of Jack Dillenberg because we are sister schools with ATSU. I have classmates from Chicago who come from wealthy families and that's where they're going back, and I have classmates from Keokuk, Iowa, a rural town, and when we moved from Kirksville to St. Louis for school, he didn't like St. Louis. It was too big of a city for him. He plans on going back to Keokuk, Iowa. That's where he wants to go.
Howard: The rural areas, infrastructure's everything. Before, the town doesn't have an interstate and cable and the internet and all that, so you can't (unclear 00:16:27). I still think the number one problem with all this rural demise is accepting kids from the 'urbans' based on GPA, and it's something that is so easy to fix. It's crazy. You talk about not letting dental school get in the way of your education. What does that mean?
Bill: I can't take credit for that one. I don't remember where I heard it, but I've love that line, not letting dental school get in the way of education because in school, they teach us the basics of dentistry. A lot of stuff they teach us, we don't even need to know. We're not gonna use it in practice, and so I don't know when I really started, but I realized that a lot of the stuff that I felt like was going to make me successful in clinically and in business, I was going to have to learn on my own. Whether that's through Dentaltown or that's through going to conferences like I'm at this weekend, I've just kind of made it a point to not count on the education I'm getting in dental school to give me the education I need to be successful, because I think if you just took the education you were given a dental school- They offer a class here or there about practice management, but it's so insufficient. If you just took that education and then went into private practice, man, you're going to be so far behind and stressed, so I think it's important for pre-dental students, for young dental students to know that you have to take initiative and really on your own go out and seek out, listen to the podcast, get on Dentaltown, go to the conferences, they all offer student discounts. you know? It might be a couple hundred bucks, but the return on investment is huge on that. That's just something I'm kind of passionate about, not letting dental school get in the way of your education.
Howard: Yeah, think of the eight years to be a dentist. I've been out thirty years; do I use math, calculus, geometry, trig, physics? You're right, and then when you get out of school and all my classmates of '87 graduated and the ones that opened up their own practice a week later, they needed to make payroll. You'd think they would have maybe covered payroll, so I had to get A's and geometry and calculus and physics, but you couldn't be bothered teaching me how to make payroll? I graduated before computers. Really? No peg board system training? No payroll? You couldn't even give me the payroll chart so I knew the deductions per kid? You know what I mean?
The ones who do the best, and this is in every occupation- About 25% of people go into family occupations. Even names like Smith - they were blacksmith. Taylor were tailors. When you go around the world, like in Kansas, if you were graduating high school and you went into wheat farming, three guesses what his dad did. You just can't graduate from high school, never seen a weed farm and decide you're going to be a wheat farmer, and the thought of graduating high school and saying, "Yeah, I'm going to go buy a square mile is six hundred and forty acres and build a ranch and buy a (unclear 00:19:47)…" That's just not how it works. Usually, your dad's a wheat farmer and your grandma and grandpa are going to give it to you when they die, and if they have two siblings, they cut the farm in half and then, hopefully the other sibling will want to go be a dentist or a lawyer and you can buy him out or something. So, all around the world, families go in to this this, and then those are the ones that have a huge advantage because they grew up in a dental office and they saw reality. Where it gets scary is when I'm going to start my own practice, your dad and mom weren't dentist, your mom stayed at home and your dad worked at a factory or worked for UPS, and your dental school didn't teach you anything, and you know what you know and you have this false confidence because you don't know what you don't know.
Bill: And I think it's the thing that's scary to me too, is that I see it in my classmates, I see it in other students that there's this assumption that you become a dentist, you make good money. With the amount of debt that they're coming out with now, that's scary because they don't have the business background, and like you said, they're not even skilled enough clinically to be successful right when you graduate. It's a big reality check for a lot of people, I think, as soon as they graduate that you might make some money, but so much of that is going back to your student loans and then you've got the headache of running a business. It's just kind of a recipe for disaster.
Howard: Now, were you aware in dental school that when you're a dental student all the continuing education on Dentaltown is free?
Bill: Yeah, I have been taking advantage of some of it.
Howard: Do most of the classmates know about that?
Bill: Nope.
Howard: Yeah, spread the word on that man, we have four hundred and fifty courses. I think they're some of the greatest courses period and they're all ADA approved, ADD approved. We take it more seriously than a heart attack and we make that free for all dental students.
Bill: It's awesome. A couple of weeks ago, I think I was watching one of Cory Glenn's CD that he put out about composites and it's all free, it's all there, so I'm kind of sad that it's not going to be free here in a little bit, but that's great.
Howard: If you start following the science of learning, you see the eight to five, Monday through Friday, education for grammar schools' all wrong. They're saying that these little kids, they can't even start coding long-term memory till ten o'clock. They can only listen to a teacher and focus at the maximum fifteen minutes and the average is probably seven and a half, so going to a seminar all day from eight to five to listen about a root canal, you have no idea how many hours you're dreaming around fishing out in Cabo and what you're going to do tonight, and you're texting and you're on Facebook and all this crazy stuff. What I like about online CE, it's one hour and you're an adult doctor of dental surgery and about an hour is all your walnut brain can do to take that in, and then you don't have to take notes or anything because it's all there so if you ever wanted something who could just pull it back up. I think the human mind, an hour of concentration is pretty much max. I remember Oliver Stone. There's only four or five guys who have made more than fifty or sixty movies in their lifetime. It's a very rare club, and Oliver Stone's one of them. I remember one time he was getting grilled because during JFK and Watergate he had this one character and he did two things that everyone knew was two different people. He said, "Dude, I got a hundred and ten minutes max. You want me to introduce a whole new character for this one thing?" They said, "Why does is have to be a hundred and ten minutes? Why don't you do it right?" and he said, "You can't hold their attention for more than a hundred and ten minutes minutes." That's two hours and we try to make our online CE courses one hour, this podcasts an hour. You're a human being and you have to know your limitations. Within two hours, you're hungry, you got to go to the bathroom, you're wondering if Morgan needs you to call her, you know what I mean? Your mind is just playing all kinds of tricks on you. Any ideas of how to get that dental CE is free to dental students? Do you guys got an email or message board or anything?
Bill: We have class facebook page.
Howard: I'd really appreciate if you post that because some of those courses, we are so proud of. That endo one is nineteen hours long. It cost $1,000,000 and five years to make, and my endodontist friends look at that and said, "Son of a gun, you took the whole world of endo and this endodontist from California and got it in one course." As great as your endodontic instructor would be, when he or she would prepare for a class, she never spent five years to make nineteen one-hour lectures and the video and the taping. That's something where they could watch that one class before they graduate and literally just like- How many endos will you have done when you graduate?
Bill: Total, I think around ten.
Howard: Good.
Bill: Yeah, I've done three or four molars.
Howard: We had two gentlemen here yesterday that just graduated a year ago and one graduated from dental school and done zero, and the other one had done one. From Louisville.
Ryan: Yeah, I think it was Collin Larson and Matthew Free.
Howard: He had the same name as you. Interesting.
Ryan: They're spelled a little different.
Howard: They're spelled a little different, but there's no difference. Did you know that?
Bill: Yes, I think a lot of them, a lot of the F-R-E's-
Howard: The Mormon church is very big into genealogy, and so I thought for the boys (unclear 00:25:51), I'd go down to the Mormon temple and have them work out of the family tree and it was an incredibly fun experience and there's all these volunteer retired ladies and they just worked it to the bone and they were just-
Bill: Oh, I'm sure. They were salivating when you walked in.
Howard: But this is what they told me. They go, "People come in here and they think it's a mathematical periodical table because that's not how it is." 1880, 80% of the planet can't read or write. So then these small towns started popping up and they all had one church and that was on Sunday, and so they would use that for the school and the minister would try to get them to do schoolings and none of the men would give up any boy-
Bill: Because they needed them to work.
Howard: They needed them to work the farm, they needed to eat. So, the only thing they would give up was a small girl who wasn't big enough to break a horse plow, fix a fence. So they sent these little bitty girls, probably three, four years old, and they only stayed there till they were big enough or where dad could say, "You can hold, you can plow," and then they teach this little girl the alphabet and they'd all this and she's the first person in the pedigree that went to school. "What's your last name?" "Free." "Well, how do you spell it?" "F-R-E-I, F-R-E-E…" So, when you've been doing genealogy like these ladies have over in Mesa for ten, twenty years, she said, "All the sudden, your name pops up in Ohio and it's in seven different counties and it's spelled three different ways. I guarantee you that's the same tribe." And then the craziest one is when there's no translation from Islam to English or Russian. When Muammar Gaddafi died, his obituary, they spelled his name different in the New York Times, the L.A. Times, (unclear 00:27:52). Some spelt it Kaddafi with a K, someone's Quaddafi with the Q-U, and then people were saying, "What's the right way to spell it?" In Arabic, but there's no translation tool from Arabic to English. It's art. So, it's art and science, and dentistry is always going to be art and science because it's only science when we know, but when we know that there's things we don't know, then it starts being art, and since I doubt they will figure out the entire human body for another couple thousand years, there's a lot of art and science into dentistry. You say the dental fraternity's best in the world. What's the dental fraternity and why is it the best in the world?
Bill: I've heard you talk about that a lot. You're joining the best fraternity in the world. There's just something unique about the people in dentistry that they're so willing to welcome you and teach you. Just this weekend, I just sent you an email and said I'd love to meet you and you invited me into your home and to be on the podcast. Not many people will do that. I'm actually leaving today to go to San Antonio to Scott Luna's breakaway course there. I followed Joshua Austin. He's a dentist there in San Antonio. His dental office (unclear 00:29:13 lectured, and I sent him a message on Facebook, said, "Hey, I'd love to just meet you for lunch," and he invited me to come to his practice and shadow him and it's just an amazing group of people who were so willing to share their knowledge with you. It's just something that I think is awesome and that everyone should take advantage of too.
Howard: What type of person wants to go to eight years of college to do 100% hands-on surgery in an operatory on humans for the rest of their life. That's very different than someone who wants to be a lawyer. As bad as that sounds, it just is. Remember that when we were talking about online continuing education earlier, because so many dentists are shy introverts and they fly across the country and drop $2000, $3000, $4000 on these courses, on implants and things. They could have walked across the street to the periodontist, the oral surgeon and maybe, maybe what percent think in fear and scarcity, I don't know. I'm sure less people think in fear and scarcity in the South than they do in Manhattan and Brooklyn. I just had a really good gut feeling on that because I've lectured at all those places. My gosh, you're flying over to Santa Barbara and all these (unclear 00:30:40) to learn how to do a root canal, and there's a good old boy endodontist across the street who's a board-certified endodontist, been doing it twenty years, you're just a baby that walked out of dental kindergarten, they all want a friend. They all share your enthusiasm, your passion. You could go sit and be his dental assistant, any procedure, anywhere, anytime and for no money, and then what's really great is then you place that implant and you get into trouble someday, well he's your buddy, and your buddy fixes it. Whereas the buddy that you flew across the country and dropped three grand on, he doesn't even remember you were in his lecture.
Bill: Yeah, it's true, and then half the time you're at the lectures and you're sitting out in the hall, on a phone call or something so yeah, it's true. I think that people forget that we're not competing with each other, we're competing with people buying from a new car or buying from Amazon. We're not competing with each other, and so it's so important to use those resources to your advantage.
Howard: The new car thing, it's a starting point, because the average new car in America is $30,000. 80%, four out of every five Americans at one time in their life, between birth and death, will buy a new car and 5% of dentists will sell that average new car dental case once a week, fifty weeks a year, their whole career, and do $2,000,000 to $4,000,000 a year. The other eight guys in the same medical dental building will never do that one time in their career.
Bill: What separates the two then, in your opinion. What makes the-
Howard: That the skill isn't any of the calculus and algebra and physics and you have all this extra confidence because you got an A in calculus and you took calc two or you tested out of calc one and then took calc two and calc three, and none of skills matter. The thing about statistics that are interesting is you really have to have a grasp of statistics because say there's a trait, say, aggressiveness. 60% of boys are aggressive by clinical psychologists. 40%of girls are aggressive. But see that 60-40, that really doesn't describe the population because what you have to do is go to the standard deviation number three. If you took a hundred people and you said, "Who's the most aggressive person in this group?" Now it's all boys. And so, when you say what is the average dental plan case, according to Delta and the big deal's the average new patient is going to bill out about three hundred and eighty-one. The life value of that patient is going to stay in that dental office about five years, so sixty-five hundred divided by three eighty-one. 33.54 The average orthodontist new patient for Invisalign is going to be about sixty-five hundred. The average value for an orthodontist is going to be sixty-five hundred, but he's going to capture that in one or two years. The average family for a general dentist is going to be about sixty-five hundred, but he's going to capture that over five to seven years. But, when you look at that average case, it doesn't matter what the average is.
What is the top 1%? What is the top 5%? And the top 1%, and a lot of times it's the top 5%, will just sell that average new car because the other ones are going to look in there and say, "What is your problem?" "This teeth broke." So, one tooth dentistry, and then it takes four or five years for you just to build on her, say, "Since I'm going to numb up this whole quadrant, I might as well do this whole quadrant. I don't want to numb up both sides because then you might bite your tongue," even though you practice down the hall from an oral surgeon who numbs up all four quadrants, pulls all four wisdom teeth, all day long for age twenty-five to sixty-five. So it's all these mental blocks and somewhere between 1% and 5% are doing this new car. If you really want to see data, go to CareCredit, because the best thing CareCredit does- Forget about patient financing, which is their business; they can come in there and show you, in your zip code, all the dentists and what their average deal is, because when they go in there, the first thing you're going to say is, "You don't understand. I'm in a poor area and they're poor and they're big families…" and all this. I had a dentist tell me this in Kansas last week with Ryan. It was unbelievable. And as he's telling me this, we're having lunch in the small town of five thousand and you can see the Seven-eleven across the street. As he's telling me all this, I'm just looking at the parking lot, saying, "Look, there's nine cars in the parking lot and five of them are F-one-fifty pickup trucks. Just tell me how much is an F-one-fifty pickup truck? Aren't those about sixty?" And he goes, "No, see that black one? That's fully decked out. That's like ninety-eight, and that other one over there, no way that's under eighty-five." I'm like, "Okay so, five of the nine cars are between $60,000 and $100,000 F-one-fifty pickup trucks, and you've never sold one $30,000- What's a $30,000 car? Ford Taurus? You've never sold a Ford Taurus in thirty years of practicing dentistry, but some salesman has dropped five F-one-fifty trucks?"
Bill: Yeah, it's the mentality.
Howard: It's a mentality but it's your self-limiting beliefs. It's just always yourself. These other guys that come in there and say, "Bill, what are you doing? How are you doing? How's Morgan? How's the twins? When's that baby due?" and communicating and accessible and making you feel connected, and then say, "Okay, so here's the deal. Here's all your teeth. You got great teeth, man. That is awesome. I mean, you've got to realize we're in America by sixty-five, 10%, have zero teeth and by seventy-five, 20% have zero teeth. You got a lot of teeth." You want to reward them (unclear 00:37:24). "You removed your wisdom teeth, you're doing so good, but here's all your cavities, here's what we need to do, here's the whole thing." My God, basically there's only a couple of questions. Half of Americans are afraid of the dentist and wants me to bring in a board-certified anesthesiologist and knock you out so you'll be asleep, you'll wake up, and it'll all be done. The other half aren't afraid, and then the other half is when people go buy a Ford One-Fifty pickup truck, they don't go in there and write a check for it. They finance and, "Carol here ran your credit history and to do every single thing you needed, it will be $331 a month for sixty months. So, when do you want to do it?" And they're like, "I definitely want to be put to sleep, and I definitely do three thirty-one a month and I don't know… How about next Friday?" And they do that every week. They do that every single week and it's just- Dentists are so funny. I love them to death, but you'll ask them, "What courses do you want?" They want more occlusion. They want more TMJ.
Bill: Sleep apnea…
Howard: Sleep apnea. Yeah, it'll fix your hair loss and erectile dysfunction, and you'll never be fat again… It's just like, my gosh really?
Bill: It's a part of the thing I mentioned earlier about not letting dental school get in the way of your education. That carries on even after dental school too, that I think people need to realize that it's not- Some people I feel like are afraid to make money in dentistry that because they feel like they're robbing their patients or something, but in reality you're not doing anything they don't need, like they need these procedures. It's just a matter of are you going to be the one to do them or is someone else is going to do them? So you really have to have confidence, like you said, I think it has to be a mindset that the procedure needs to be done and you have the skillset to do it, so then it's just a matter of presenting it to the patient in a way where they're confident in your abilities and they're willing to accept it and presenting it in a way that they feel like they can manage it financially too. That's something that you're just not taught in school though.
Howard: You don't even need this skill set to do it. Let's say you have a dollar and you do a dollar in sales, that's a 100% overhead. You still have your dollar (unclear 00:40:01) and now you do $2 in sales, now your overhead went from 100% to 50%, and if you're doing $2 in sales on a dollar a month asset or $2 a year in sales on a dollar a year in costs, you have a 200% return on asset. So instead of going out and learning how to place implants and dropping big money, flying around the country and getting implant kits, that kind of stuff, if you just sit there and say, "Who do I want to place implants on Morgan. Well, no one will do it across the street, but maybe the-" I'm in Phoenix. I can get out to Tucson and get half the periodontists and oral surgeons to come down to Phoenix one day a month and place all my implants and split it with them fifty-fifty. So now, I have no implant inventory, just like anesthesiology. I don't want to learn anesthesiology. I don't want to get advanced cardiac lights support. I don't want to be on a witness stand someday, having a Doctor Board MD guy going over my emergency protocol and have an accent so I can just bring in an anesthesiologist for- Everybody that delivers a baby, the doctor just had a text and they're sitting in the waffle house, they're sitting at the IHOP, they're there in five minutes. As far as placing the implants, you don't even need the skill set. What you need is to be able to attract and retain quality key staff and attract and retain quality key customers, and those customers come in there and you say, "This is a pretty complex case. We're going to have you come in and I'm going to bring in Charlie, he's going to put you to sleep, he's with Ed, the oral surgeon, and he's going to place them…" You don't even need these skills. You don't need these skills.
When you talk about sleep apnea, what really concerns me about sleep apnea is that in 1900 there were no specialties and healthcare was at 1% of GDP. By 2000 and healthcare was 14% of GDP and the MDs had fifty-eight specialties and the dentist had nine. Now healthcare is up to 17% of GDP. It's going from no specialties, ow we're at fifty-eight, nine- What is that? Sixty-eight. We're headed towards a hundred specialties, so when you say I'm going to add sleep apnea, I'm like, "Dude, are you even good in molar endo?" When you told me you're going to add sleep apnea, my first question is, "What are you going to take away?" "Oh, I'm going to master endo and perio and pedo and sleep apnea and Invisalign and occlusion and-" So we're going back to 1900? So you're going to be that one guy? What are you going to do after that? You're going to start doing ophthalmology and (unclear 00:42:50) Where does it stop? Then you have another model where you sit there and say, "I don't like molar endo, but I'm in a small town and I'm going to get an endodontist from Phoenix to come up to (unclear 00:43:04) one day a month and I'm going to stack up all my molars and do them all in one day or vice versa. If you went to the hospital, you wouldn't want them to say, "I've got to send you over here to get an X-ray and four miles over here to fix your broken leg and three miles out here to-"
Bill: Yeah, (unclear 00:43:22) patients (unclear 00:43:23) bring the specialists in.
Howard: If you were an endodontist or any form of specialist and you came out of school right now and you had $400,000 in debt, really your best idea is to go buy a $500,000 office? Then what's your next question to me? "How do you advertise and market to get these referrals?" Shit, I would've walked down to L.A. and said, "What are the ten biggest practices in L.A.?" I'm an endodontist, and then I would have got the ten biggest ones and I'll do Monday morning your office, Monday afternoon, your- You know what I mean? They had to split it fifty-fifty, so now you have guaranteed 50% overhead and unlimited patients and if you're showing up to the office they don't have work, another office's calling you to come in. Dentistry has a long history of not putting the patient first, but putting the dentist first. They have bankers hours, they send you to nine different locations to get something done. In Phoenix, Arizona, where you drove up the streets in my house, if you were to wreck your car, the ambulance would have been here, the firetruck would have been here and they'd take you to a hospital fully staffed. But if you were just walking up the doorway and tripped and fell and split knock your front two teeth off, do you think right now if you were to trip at my front door and clipped (unclear 00:44:42) that we could have found someone to fix you in a dental office?
Bill: Not today, not a chance.
Howard: No, it's impossible. So the customer's screwed. I can get a pizza delivered, a fireman and a policeman will come to my house and when your Morgan drops that third baby, she can do it on Easter, Christmas, Hanukkah, doesn't matter. They're ready, but not dentistry, and then the killer, sucker punch is 8% of emergency room visits are odontogenic in origin. That's almost one in ten. In fact, if I was going to start at another business model, that's another amazing business model- If I was a young graduate and I had $400,000 in debt, I'd go to the biggest Hos- They say, "Nobody needs a dentist in this town. It's too big and crowded." Yeah, I would go talk to the hospital administrator. I'd say, "Why don't you give me free rent and fifteen hundred square foot down the hall from that emergency room.
Bill: So they've got dental urgent care?
Howard: Because they want to deal with heart attacks and strokes and deliver babies and all this stuff. They don't want you tying up some room in there, and then we have to go in there and give you Vicodin and Pen VK and then $1,500 of billings later you leave and we're still at square one. You're still just on Pen VK and Vicodin, but to sit there and say, "Oh yeah, we got Dr. Bill Frei. Just go down that aisle. If this is a tooth, we're done with triage. So go down the hall."
Bill: So what's the solution to that though, because if you have a practice of your own, you're the only doctor in your practice. You'll get so burned out. You can't be open seven days a week obviously as a private practitioner. So what's the solution then, how do you-
Howard: That's why you've seen a continual migration from solo to group in medicine. Medicine is a whole generation ahead of us and there's a couple things that did that. One was the equipment. When you buy ultrasound and a CAT scan and an MRI, it doesn't make sense for just Dr. Frei to use it. So, as the equipment got more expensive, they had to do group and then because of group then they can shift around the hours which helped the consumer. What's ironic and laughable in dentistry is the same boneheads telling you to buy a $100,000 CBCT and $150,000 CAD/CAM and $100,000 laser are the ones all against corporate and group practice and all that stuff. Dude, you can't buy half a million dollars worth of equipment for one guy. That doesn't even make any sense at all. If you're going to buy a $100,000 CBCT and you're going to buy $150,000 CEREC machine from Dentsply Sirona and you're going to buy a $85,000 to $135,000 laser like LANAP or hard tissue laser or whatever, you need to share it with two or three or four people. And the thing is, there is no difference. I do think dentistry doesn't have to be twenty-four hours a day because being a dentist for thirty years, you can wait till seven in the morning. But if you're going to have to wait till Monday and then not even know if they're going to get you in, you're going to go to the emergency room. So I think if you were seven to seven- If you got with three guys and that's another thing. What's wrong with a twelve-hour day? In hospitals, if you graduated med school, they'll hired you and they'd say, "Hey, Dr. Frei, you're going to do a twenty-four hour shift on Monday and Thursday. That's it. That's what you do for us." No problem. And you walked in to dentistry. "Dr. Frei, on Wednesdays we want you to stay till seven." "What the hell? I'm married and have a family!" So, you could literally do a twelve-hour day on Monday, take off Tuesday, a twelve-hour on Wednesday, then take off- Whatever.
Bill: I think that's one of the reasons why a group practice model or having a partner is attractive to me because you can serve your patients better because you're going to be open more, they have access to you and your office more but you're not sacrificing your own personal health and mental health and because you need to take time off and you have someone to cover for you and cover those hours. I think that in my opinion, that model of just being a single doc and running it by yourself is going to become more and more difficult. Not that it all has to go the way of corporate, but I think involving other dentists in your practice as associates or partners I think is just better for everyone.
Howard: Yeah, and the head economist at the American Dental Association- What's his name? Mark…
Ryan: Marko Vujicic.
Howard: Marko Vuj-?
Ryan: Vujicic.
Howard: Vuj-?
Ryan: Vujicic.
Howard: Vujicic, I'll never get that name right. Marko, I'm linguistically retarded. The only D I got my life was in Spanish and my five sisters, me and my brother, I'm the only one where the piano teacher fired me. She told my mom, "Howie couldn't carry a tune and a lunch pail." In San Martine, my Spanish teacher told my mom I was linguistically retarded, so I apologize if I don't get the name right, but he used to work in the World Health Organization, the United Nations, all in the healthcare statistics and he shows just amazingly amazing data. It's all drifting from solo to group all around the advanced world and it's mainly because of the cost of equipment and being patient-centered. If your twins fell down and bust off their front tooth, you aren't going to settle for, "Well, it's Thursday and we don't open till Monday at eight."
Bill: Yeah, not a chance.
Howard: Not a chance, so what you do? You pack up and go to the emergency room, and then they can't do anything.
Bill: They can medicate them and send them home.
Howard: So they'd say, "Here's the pain pills, here's the antibiotics, this will do nothing. This is all voodoo, tinctures of time and come back Monday." So are you excited about joining the army?
Bill: Yes, the army. It's really a new experience. No one in my family served in the military and so it's all new to me.
Howard: So, you couldn't get in the Marine Corps because army stands for Ain't Ready For Marines Yet.
Bill: Oh, I don't know. Yeah, it's fun. I went to the nearest base to St. Louis to get my uniform to get ready to go to officer training and just from being in dental school, I'm already a second lieutenant as far as rank goes and you pull up to the base and there's someone there to check your ID and usually the person checking the idea is a lower rank and so they saluted me and I don't know anything yet about the military, so I was like, "Oh, hello." I didn't know what to do, s it's all so new to me, and I guess that's why they send us to-
Howard: Well college degree, you start as an officer. You're going to start as a doctor. You're way down the line.
Bill: So, it's interesting because I have no experience whatsoever in the military, but you're given a lot of responsibility right from when you start. We're going out. I go to officer leadership course and then we'll go out to a Tacoma area to do the AGD. So I'm looking forward to that. I think we'll get some good training there.
Howard: Dentistry is a good fraternity. I think Dentaltown is an amazing fraternity. The military dentist, that is to die for, but what I want to salute the military dentist for is when my boys were growing up- I have four boys, Eric, Greg, Ryan and Zack, and anytime we were going to Disneyland or San Diego Zoo or Legoland or whatever, I would post on Dentaltown, "Hey, I got my four boys and we're at this hotel and there's a big old military base. I could see aircraft carriers and Triton submarines. Any dentists on base that could give us a tour?" Oh my God, so many dentists said, "Nobody gets on here-" This was after nine-eleven, which was eighteen years ago. What year is that? 2001? So this was seventeen years ago and they said after nine-eleven, everything changed, but their ranking was so high that meeting some short fat, bald guy with four kids at the gate- I said, "Who outranks you on this aircraft carrier?" and he was basically the top dog and then we visited him and he let us sit on the steering wheel and drive the deal- It was amazing. We saw so many amazing submarines and aircraft carriers and bases, but also you can spot the passion because I never, ever, ever went on one of those places where the top dog- I don't know. I know in the San Diego and the Marines, they met a one star general trying to recruit all four of my boys, even when they were two, four, six, eight, and they were giving them this big old- Do you remember any of these?
Ryan: I remember going on the ships and everything, but I don't remember being recruited.
Howard: Oh my God, there was a general in the San Diego Marine Corps area and he literally spent a half an hour trying to sell the passion. Oh my God.
Bill: If you're at that high of a rank, I bet you've been in there for a while. That's your life. You're passionate about that.
Howard: You're going to love the fraternity there. That is one tight family. So, do you feel you're weak in a clinical area that you want to learn in your residency? Are you sitting out the residency and saying, "We didn't get much of that at school and I really want to learn that."
Bill: Yeah, there's two things that kind of stick out to me. One is placement of implants. We placed implants at the school, but the periodontist placed them, you assist them. So, if you have a patient that needs them, schedule them with the periodontist and they're the ones that place them. We don't have any residency programs at my school so we get to experience everything, but that's kind of one thing that they just don't let us do is actually place the implant. So, I'd love some training in that. And then, I've extracted a ton of teeth at school but not a lot of impacted third molar, so that's something I'd like some more training on too. I've done erupted third molars, but impacted wisdom teeth I think could be-
Howard: The cash cow is extractions and endo. How's your molar endo?
Howard: I feel good about it. Like I told you, I've done only four or five at school, but that's more than I think a lot of people get in school and I enjoy endo so yeah, that's definitely on the list as well, getting more experienced doing endo.
Howard: Nice, and extraction is a harder skill than placement of implants, so it's awesome you got a lot of extraction skills. By the way, if you don't know where to learn extractions, go look in your newspaper. Where is Denture World? Where is Dental Universe? Where is- Every one of these metros got someplace that's Denture World and they have these guys in there that have been chucking teeth and putting full arches in forever and you'd go down there and you just say, and they'll actually hire you. You could say, "I'm going to go down there every Saturday or take one day a week," and they'll probably pay you 25%. It might be a low fee schedule, but what's so cool about it is you got friends and colleagues in your backyard and if you get stuck pulling out that tooth, you've got a guy over there in the next operatory who has been extracting full mouth extractions and loading immediate dentures his whole life. It was amazing doing that back in the eighties where they had dentures down to three steps back then. (unclear 00:56:33) mush bite, and you can sit there and say, 'That's low class, sloppy, they didn't mount it on a semi-adjustable… Where's the face bow transfer?" Well, there's no face bow transfer when you're selling a used car. Then there's a Chevy, a Pontiac, an (unclear 00:56:51), all the way to a Cadillac, a Mercedes Benz, and you might say, "I want to build a Lamborghini." Well, good luck with that because America is the richest country in the world and they only bought three hundred of them last year, but they bought a million Ford Tauruses and I didn't mean that literally. A million. And just a heads up on the implants, 20% have peri-implantitis at five years and at nine to fourteen years it's 60%, and there's a lot of people. I'm hearing this from many different areas and many different countries and a lot of them would come on the show that, that inert titanium isn't inert as you think it is and it's causing inflammation and that's a big part of it, and a lot of people are not seeing that on the ceramic implants. If you think, "That's all hearsay, Howard. That's baloney faloney." Really? Well, follow the money. Straumann, which is the largest implant company in the world as measured by sales and units, they just bought one of the largest ceramic implant companies. So, that's something you might want to start thinking about too. So, where are you going to learn your business and practice management?
Bill: I had a little bit of experience in an undergraduate as a business management minor, so I got a little exposure to business marketing and then I'm just going to these courses. Like I said, while I'm in school, I'm listening to the podcast, I'm going to the business dentistry, business conferences.
Howard: Now where were you born and raised?
Bill: In Idaho Falls, Idaho.
Howard: And where was Morgan born and raised?
Bill: She was born in Clovis, New Mexico, and then her dad was in the air force and so she lived in San Antonio, she lived in Italy, she lived in lots of places.
Howard: Where's your mom and dad live?
Bill: They live near Seattle.
Howard: So what are you guys going to do after for- What's the chance you'll stay in the military twenty years?
Bill: It's hard to say, because like I said, no one in my family's been in the military so I could get in there and love it and stay in long-term. I'd like to own my own practice and to do my own thing, so I guess time will just tell. If that's the case that I do get out into private practice after my payback, than it's probably likely we'll end up back in Idaho somewhere. My family's there and her family is thinking about moving to Idaho.
Howard: I love Idaho.
Bill: Yeah, it's great. I love it there.
Howard: I want to figure out how I can live in Phoenix in the winter and Idaho in the summer. Maybe we could switch dental offices. You come down here when it's a hundred and ten and above.
Bill: I don't know about that, man.
Howard: Four or five months. It's just so gorgeous.
Bill: Yeah, it's like one of the best kept secrets. There's everything you need, outdoors-
Howard: And I'm Irish, so that's potato country, so that's the official Mecca of all the Irish people.
Bill: I grew up on that stuff.
Howard: I think that's why they actually left Ireland for the famine and when they came here they stopped to Boston. They should've gotten all the way to Idaho that has all the potatoes. I would say it seems to me like half the people I know that enter the military, they say they're gonna do it four years, half of them to stay for twenty and then they open up a private- It's just a great gig. (unclear 01:00:09). A little premature, but let's say you're going to do four and leave. Would you buy a practice or would you start one from scratch?
Bill: That's the big question that I've actually thought about a lot because obviously if I acquire a practice, there's immediate cash flow but at the same time there's something to me about not inheriting someone else's staff, inheriting someone else's broken systems and being able to implement all that stuff the way that you wanted from the beginning that's really attractive to me. That's what I'm going to the startup course at breakaway this weekend. It's because it's really interesting to me.
Howard: Scott Leune. But I can tell you this. The fact that you're even thinking about all this stuff and you haven't got out of school- I've been watching guys like you graduate for thirty years and guys like you who are serious, networking, thinking about it before graduation, every single one of you guys crushed it.
Bill: Well, that's good to know. I appreciate it. I think it's something I'm just passionate about and I love dentistry. There's so many different avenues and ways to enjoy the field of dentistry. Doesn't have to be a job. It can be a great career for you, so it's something I love.
Howard: Well thanks for coming on the show.
Bill: Yeah, thank you, I've loved it. Thank you so much.
Howard: And back to saving those rural guys. If you can find any information about what the Indian public health is dangling-
Bill: Look at those numbers, yeah.
Howard: Or getting into those numbers from your classmates (unclear 01:01:38) because there's a lot of guys in towns of five thousand where he's the only guy in town. The saddest case I saw, I was lecturing in London and there was a dentist there actually from an island and this island had like fifteen thousand people on it and he put up his practice for sale fifteen years ago. I think there's about fifteen thousand because you know around the United Kingdom, there's lots of little bitty islands there and nobody would buy his practice. He closed down his practice, but they all knew he was the house next to it, so they knocked on his door and his wife would say, "Billy, go back there and unlock the office." So he'd been practicing ten years past what he wanted to do and I tried to explain to him this thing called the Internet and Dentaltown. Dentaltown has sixty-five hundred free classified ads on it right now, and dentists need to dangle these incentives and if all you had to do- And a lot of these guys are only making two x of one third their own hygienist is making so they're going in the Indian public health service, say for a hundred grand, their hygienist's already making fifty, but she can only do cleaning exams and fillings. These guys can do root canals, buildups and crowns. So it just makes so economic sense that if there's a hundred and sixty-eight hours in a week, but you're in this mindset that you can't get an associate to come out in Western Kansas-
I'll finish on one note. It was the same thing with the hygiene situation. The dentist can't get a hygienist to go to a town of five thousand, so I've been telling him for thirty years what you do is in the high school, you have an essay contest and why you want to be a hygienist, and if you won the essay contest, you get free scholarship to hygiene school. So several dentists have done this over the years, I mean, dozens. One guy called me one time and said, "I don't know what to do. Two girls did the deal. Do you want to read this?" I said, "No, you need two hygienists, you need two full-time hygienists." But those girls didn't get accepted to hygiene school because they didn't have the A, you needed to have a three point eight five. Again, filling up the whole class with girls from Wichita, Kansas who were never going to drive two hours out into Western Kansas to have a job because the deans have no concept. So really? That A in English that's so important that there's shouldn't be a hygienist in Western Kansas? Really? So, demographics matter. Thanks so much for coming by.
Bill: Yeah, thank you so much.
Howard: Best of luck. Thank you, Ryan for working on the Greek Orthodox Easter.