Founded in 2004 by a fresh graduate from the College of Dentistry at the University of Oklahoma, Dr. Lance Schmidt. A glutton for punishment, Dr. Schmidt had actually just finished an extra year of study, completing the prestigious and highly selective Advanced Education of General Dentistry program, also at OU.
After consulting with an experienced dental practice transition attorney, dental CPA and dental practice consultant (with over 90 years experience in dentistry combined), he bought a practice at the age of 28. After highly overpaying for this practice, he then proceeded to work 7 days a week for the next three years - moonlighting at other clinics in addition to his 4 clinical days a week, at Reflections. He even mowed his own lawn and did the weekend cleaning during that time, just to keep his head above water.
Finally, after three years of abject misery, struggling just to make ends meet, he and his wife, Stephanie, who also worked at the clinic as the sole dental hygienist, were finally able to write themselves a paycheck.
He then proceeded to flip the traditional start-up model on its head. So usually a young dentist goes in to partner with a dentist nearing retirement, at their practice. In Dr. Schmidt’s case, he hired one to come work for him. In the process, he met a lot of his loyal patients and when the other dentist was ready to retire, Dr. Schmidt merged three practices into one and soon hired his first ever associate dentist.
After deciding to focus on growth and developing leaders within the office in 2012, the practice has grown 220%. They have a team of 18 people including three total dentists, three full-time hygienists, four dental assistants, a variety of admin personnel and even their own marketing director.
Also joining us today, in addition to and at the request of their Commander in Teeth, are some key members of the team. Joining us are both Associate Dentists, Dr. Kimberly Greenlee and Dr. Marie Bockus.
Dr. Bockus earned her doctorate from University of Oklahoma and is married with three young kids, speaking of which, she actually enjoys treating children and provides that service whenever possible at Reflections, thus extending the life expectancy of the other doctors by at least ten years.
Dr. Greenlee earned her undergrad at Texas Christian University but added her dental doctor initials also at the University of Oklahoma. Married with two boys, she’s practiced dentistry for over ten years and really enjoys a good root canal.
Also joining us today are: Executive Assistant Kensie, Hygiene Team Leader Nicole, Her partner in crime Betsy, Front Office Team Leader Lindsey, Acting Dental Assistant Team Leader Ebony, Current Call Take and Transferrer but future student at OU’s College of Dentistry Ali, and finally their in-house Marketing Director Chris Lam.
VIDEO - DUwHF #1019 - Reflections Dental Care
AUDIO - DUwHF #1019 - Reflections Dental Care
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Howard: We are in Oklahoma City and it's just a huge honor to be podcast interviewing the entire staff, the entire team, of Reflections Dental Care. Reflections Dental Care, founded in 2004 by a fresh graduate from the College of Dentistry at the University of Oklahoma, Dr. Lance Schmidt. And he's sitting next to his lovely wife, who's a hygienist, then we have two more hygienists, then we have the marketing man, then you just got accepted into dental school. How long have you been out of dental school?
Marie: Ten years.
Howard: Ten years. You're a freshman in dental school. How long have you been out of dental school?
Kimberly: Twelve years.
Howard: Twelve years. You're Dr. Schmidt's assistant, personal assistant. You're ...
Lindsey: Front office.
Howard: Front office. And you're a dental assistant. So, I got everyone right? So, Dr. Schmidt had actually just finished an extra year of study, completing the prestigious and highly selective Advanced Education of General Dentistry Program at OU. After consulting with an experienced dental practice transition attorney, dental CPA and dental practice consultant (with over ninety years' experience in dentistry combined), he bought a practice at the age of twenty-eight. After highly overpaying for this practice, he then proceeded to work seven days a week for the next three years, moonlighting at other clinics in addition to his four clinical days a week at Reflections. He even mowed his own lawn and did the weekend cleaning during that time, just to keep his head above water. Finally, after three years of abject misery - are you talking about your marriage or the dental office?
Lance: It was the dental practice.
Howard: ... struggling just to make ends meet, he and his wife, Stephanie, who also worked at the clinic as the sole dental hygienist, were finally able to write themselves a pay check. He then proceeded to flip the traditional start-up model on its head. Usually a young dentist goes in to a partner with a dentist nearing retirement, in their practice. In Dr. Schmidt's case, he hired one to come work for him. In the process, he met a lot of his loyal patients and when the other dentist was ready to retire, Dr. Schmidt merged three practices into one and soon hired his first ever associate dentist. Which one was that? You or you?
Marie: Neither one.
Howard: After deciding to focus on growth and developing leaders within the office in 2012, the practice has grown 220%. They have a team of eighteen people, including three total dentists, three full time hygienists, four dental assistants, a variety of admin personnel, and even their own marketing director. Also joining us today in addition to and at the request of their commander-in-teeth - oh, I love that - are some key members of the team. Joining us are both associate dentists, Dr. Kimberly Greenlee and Dr. Marie Bockus. Dr. Bockus earned her doctorate from the University of Oklahoma and is married with three young kids. Speaking of which, she actually enjoys treating children and providing that service whenever possible at Reflections, thus extending the life expectancy of the other doctors by at least ten years. Dr. Greenlee earned her undergrad at Texan Christian University but added her dental doctor initials also at the University of Oklahoma. Married with two boys, she's practiced dentistry for over ten years and really enjoys a good root canal. Also joining us today is executive assistant, Kenzie. You're Kenzie? Hygiene team leader, Nicole. There she is. Her partner in crime, Betsy. Front office team leader, Lindsey. Nice! Acting dental assistant team leader, Ebony. Current call take and transfer, but future student at OU's College of Dentistry, Ali.
Howard: Allie, but it's spelled kind of Ali?
Howard: Like Muhammad Ali.
Ali: Just to throw you off!
Howard: Are you a boxer?
Howard: And finally, their in-house marketing director, Chris Lam, whom I assume wrote this colorful introduction - and I am so jealous of your man bun. Well, congratulations. So, how long have you been out of school? You graduated what year?
Howard: 2003, and this is 2018. When we do our podcast show, 25% are still in dental school, like this man here. What was your name?
Howard: And you're a freshman at OU?
Howard: And where's that? Norman?
Blake: No, it's in Oklahoma City.
Howard: Oh, it's down in Oklahoma City. By the Thunder Stadium?
Blake: It's over towards the worst part of town.
Howard: The worst part of town. Well, actually the worst part of town is the best thing for dental schools. It's really the best thing for dental schools because what they're starting to do, like you go to Kansas where they had KU Medical Center. Well, it's just little bitty Lawrence, Kansas. You're not going to see very many cases there. So, they're trying to move all those medical schools and dental schools to Wichita or Kansas City. I was in downtown Kansas City. You need a lot of people to see a rare case. So, you want to be where there's the most people and the crazier the better, because you're not going to see trauma in a retirement community, they don't get in fistfights and bar fights at the trailer park and all the retirement communities, but in Arizona ... but anyway. So, 25% are still in dental school and the rest are all under thirty. I mean, I only get one email a week - and I would say email me: firstname.lastname@example.org, and if you want to listen to me, I have a face for iTunes, but if you want to see manbun, you should subscribe to YouTube Channel. It's youtube.com/dentaltownmagazine. But what advice would you give to these kids in dental school, fifteen years out, building this super-successful office? How would you tell them to proceed on their journey?
Lance: That's a really huge question. I would encourage them to really find their passion, their niche within dentistry, whatever they love doing. If it's orthodontics, if it's cosmetic dentistry, if it's kids, really figure out what it is that you want to do, what really makes you happy in dentistry, and just go for it.
Howard: So, what was your passion?
Lance: I love cosmetic dentistry and implants. I finished dental school, my requirements, about six months early and I would go into the implantology clinic and just volunteer to do work. So, that's why ...
Howard: So, are you restoring implants or are you placing them?
Howard: You're both. And what system did you go with?
Lance: Implant Direct. We started with Zimmer, and then we switched over to Implant Direct about ten years ago.
Howard: And why did you switch from Zimmer?
Lance: Primarily it was cost. I could see that they were made by the same person, made in the same manufacturing facility, it just had a different name on it and a much lower cost.
Howard: So, you thought Implant Direct was making Zimmer's implants? They were cloning them?
Lance: Well, it was a clone of them, but initially they were being made in the same facility that Zimmer had to move out of.
Howard: And now Zimmer just put their entire dental implant division up for sale.
Lance: Is that right? I didn't know that.
Howard: But, yeah, Gerry Niznick, we did a podcast with him. He is an amazing man. I think that was his third dental implant company that he started. He started one and sold it to Dentsply.
Lance: I'm not sure.
Howard: And then he started another one. But that's your passion? Placing and restoring implants?
Lance: Yeah, I love it.
Howard: Yeah. So, what are the other ... so, you said you like children.
Howard: So, did something go wrong in your childhood that makes you like working on the screaming children or ...?
Marie: I actually loved going to the dentist as a child and had a really good experience in the dental office, and so I wanted to help kids and I love kids, so it's my goal just to make them have a great experience.
Howard: That is so cool. I mean, if I had to be a pediatric dentist or go to hell, I would go to hell! I would rather be the night manager at the IHOP. It's really cool, because some people don't like blood and guts. They come out of dental school and they say, "No, I just want to do the white and fluffy stuff. Invisalign, bleaching, bonding, veneers", and then some people like blood and guts. Like I love wisdom teeth, surgery, implants. I like to get a scalpel and lay a flap.
Howard: When a polar bear gets pregnant, she has to ditch her dad because Dad's not going to chase a seal when his baby's laying there. He thinks Dominoes just delivered him dinner. It is. You can't talk about the difference between men and women without you being accused of sexism, but there are factual, scientific reasons that in the animal kingdom, only men eat their children. So, that's really cool. Are you doing any silver diamine fluoride, or have you been looking into that?
Marie: No, I have not looked into that, but that's a good idea.
Howard: Well, I don't know. It's the only controversy in pediatric dentistry. Most of the professions don't really have any controversy, except for occlusion - and then it's just an open, free-for-all of craziness. It's like ten major world religions out there and none of them agree. But in pediatric dentistry, that's their only controversy. And I think what it is is some people just like to paint on this stuff every six months and delay it, and some like to just take them to the OR and put them under and do six pulpotomies and [inaudible] crowns, which is amazingly awesome and all that, unless you're that one kid every three or four months in America that doesn't wake up from the OR, and then it's just a complete tragedy.
Howard: So, what's your passion?
Kimberly: I like root canals.
Kimberly: Everybody always says, "I would rather do a million other things." Root canal is always portrayed in the media is the worst thing that can ever happen. So, I enjoy trying to give that service in a comfortable manner.
Howard: And you don't have to sell it. They come in in pain. I mean, you've got to sell bleaching, bonding, veneers.
Howard: Every time I go in to get a haircut, they're always trying to sell me implants and wear a wig and a rug and all this stuff. You've got to sell cosmetic stuff. But root canals, it's a service. And I think it's dentistry's most embarrassing ... I think if someone asked me what is the worst thing about dentistry in America? It's really simple. 8% of emergency room visits are odontogenic in origin because they went to some dentist in pain and he can't pull it and he can't do the root canal. I mean, imagine if you broke your leg and the ambulance picked up you and took you to the hospital and they came out there and said, "I'm sorry, we don't do legs. We just do arms and ears and noses." And there's nine specialties: endo, perio, pedo, oral surgery, oral max, but one of them is public health. So, when these dentists just decide that they don't do extractions or root canals, then America gets stuck with the bill, 8% of emergency room visits, and that's on average $1,500 a visit and all they're giving them is Vicodin and [sounds like: Penvik]. You're still at Square One. So, do you like extractions too?
Kimberly: I do.
Kimberly: And one of the things I love about working at Reflections is that we offer a variety of care. Dr. Schmidt likes cosmetics and implants, Dr. Bockus does pediatrics, I like extractions and root canals, and so, just like you're saying, we can triage those things for each other and the patient can get all of their needs taken care of.
Howard: So, you're probably too young to know what your passion is. What are you thinking it might be?
Blake: I like surgery. Just from the short time I've been around it and the little bit of exposure I've had to it, I love the surgery part of it, implants and that sort of thing.
Howard: So, of the nine specialties, who makes the most money? Oral surgeons. What are they doing? $411,000 a year each. Why? Because they pull the teeth and place implants. Biggest one. Who's number two? The endodontist. Whose number three? The crazy lady with cats that likes kids. The pediatric dentist.
Marie: I don't like cats.
Howard: You don't like cats? You will by the time you're my age if you keep doing pediatric dentistry. But the most important thing you should focus on in dental school is marry one of the women in your class.
Blake: I'm already taken.
Howard: You're already taken? Is she going to be a dentist?
Howard: Ah, man, did you sign the contract?
Blake: It's not done yet.
Howard: Really? Back out. Just back out and go back to the drawing board, because if you could marry someone that makes $10,000 a month, that's always a good deal.
Blake: That is a good deal.
Howard: Because if you marry her from twenty-five to sixty-five, $10,000 a month, $120,000 a year, forty years, that's like five million bucks, and 70% of the kids in your class, they'll marry a girl who spends $10,000 a month, so, after forty years, that's five million. So, the difference between her spending five million and her earning five million, it's a $10,000,000 Delta. So, when you're looking at that woman, I don't care how cute she is, she isn't worth $10,000,000!
Blake: We're trying to turn to work out a deal right now where she takes care of that $200,000 in student loans though. She's got a job, so maybe she can take care of that.
Howard: But it's true, it's really true; we're talking about the differences between men and women. Women from all cultures, from Asia, Africa, Latin American, Central America, all women marry with their brain. They always marry up the socioeconomic ladder. They always find someone smarter, richer, whatever. So, the men obviously at the other side, they have to go down. You could be the Valedictorian of your dental school class, see the waitress at the waffle house and just marry her that day, and it's like, "Really? You married the waitress at the waffle house? You were in school for four years of dental school and half the girls are going to be called a 'doctor', not a dishwasher", and they married the dishwasher and they always tell me how beautiful she is and it's like, "I know she's beautiful, but she ain't $10,000,000 beauty." But anyway, that's [inaudible] dental school. And so, what is your passion going to be in dental school?
Ali: I don't what to pick one yet.
Howard: You don't want to pick one yet because you haven't started.
Ali: Yes, but I am passionate about going somewhere rural when I'm done.
Ali: I've spent a lot of time in rural communities, doing - not dental work because I'm not allowed to do that yet - but just seeing the lack of everything and so finding a place where I can be most useful, and also that goes to learning how to do a little bit of everything so when someone comes and there's not an endodontist for miles, they can still get treated. So, that's the call.
Howard: Nice. I mean, when you're rural, you are public health.
Howard: You're the one-stop shop. The best way to get all that research is, you know the non-profit trying to push the dental therapist, that's Pew Research. They've done all the demographics. They've gone through all fifty States. They show you every city without a dentist. So, you can go open up Arizona ... so, what happens is, half of America lives in a hundred and forty-seven urban big cities like Oklahoma City and Tulsa. The other half of America lives in nineteen thousand and eight towns. And two out of every three dentists goes to the city, and only one in three goes to the other half. And from Texas to Canada, up this little tornado alley from North and South Dakota all the way down, just about 10% of all the small towns don't have a dentist, and so when you find that small town of a thousand, the draw is usually times two or three, because when you're in rural, Momma just knows that to go to Walmart, you've got to get in the Ford 150 truck and you're going to drive an hour down the two-lane highway. It's no big deal. And then those dentists who open up in that parking lot of Walmart, the first day they're open, what percent of the county knows that a new business has opened?
Howard: Everyone. No marketing needed. They don't take any PPOs, HMOs, whatever, so they're all like a thousand bucks for a crown, twelve hundred for a root canal, and so every dentist I know that comes out of school and in the first year did a million and took home four hundred thousand, they found a town in Iowa, Kansas, Nebraska, Arizona, they were the only dentist and it was a town of one thousand or two thousand and a county of five to six thousand. And it was just like shooting fish in a barrel. It's just amazing, and it must be a good feeling to provide something where everybody wants you.
Ali: Yeah. That's the goal. I chose dentistry because I wanted to have a practical skill that could help people.
Ali: That's the end goal of the whole thing.
Howard: Very cool. So, now, your business model, you did mergers. Tell them how you grew this thing. You bought mergers and acquisitions and rolled them into one office.
Lance: We did. We originally bought the practice in 2004. There was an existing practice in the building and we love the building and we bought the practice because of the building itself.
Howard: So, you bought the practice and the building?
Lance: Well, the funny thing is the bank wouldn't loan on the hard asset, the building itself; they would only loan on the blue sky, the practice, which the practice did not end up performing as expected, which prevented us from actually buying the building for a few years. I can't take credit for the idea of flipping the business model and bringing in an older dentist, our financial planner gave us the idea.
Howard: How old was he?
Lance: How old was the dentist?
Howard: When you say older?
Lance: Maybe sixty-five.
Howard: Oh good, I'm only fifty-five. I thought you were going to say he's fifty-four. He was really old, almost dead.
Stephanie: I thought he was older than that.
Lance: Sixty-five plus, I'll say. He was coming up on a lease renewal near us and he didn't know if he wanted to practice for five years. That's what the lease was going to say. So, we give him a soft landing in our office. We had a lot of room to share space and he came over. We cohabited for a little while, for two years. Had our own staff, our own computers, our own everything, except we shared some things like the sterilization lab and the waiting room, and then he said, "You know what? I think it's time", and so he worked for another year, part-time, as an associate and then we phased him out and about that same time we were also in negotiations, discussions, with another dental office near us, about purchasing his practice, and it wasn't really the right time for us, but it had to be the right time for him because in his office complex, they had a fire, had a lot of smoke damage. He was either going to have to rebuild or move and do something really, really big. So, we just said, "Come on. We'll figure out a way to make it work." So, we ended up rolling another practice into ours pretty soon after acquiring Dr. David's practice. It was a mess. It was really, really hard at first. Culturally we were very, very different. A lot of those patients that Dr. David had had met our office along the way. That part was easy. But just bringing in another practice on top of the merger was really stressful.
Howard: What year was that?
Lance: 2012, I think, 2011, somewhere around in there.
Howard: So, how many practices have you bought in your lifetime?
Howard: And you're in one location?
Lance: Yes, in one location.
Howard: And I always thought that was interesting ... by the way, was the fire started, was the hygienist having a cigarette in the breakroom?
Howard: It's always the hygienist smoking in the breakroom. Every dental office fire, you know, it's always, that's the one. But anyway, you just have to tell them to go outside and smoke, not in the break room. But it's really weird because in Wall Street, M&A activity is huge. I mean, every month people are buying each other and that's how they get so damn big. And then in dentistry, people just don't use that. But 100% of all dental offices I know, they got to the $3 to $4,000,000 mark, because every time an old man retired, the option was this. It's like a piece of pizza. So, say you're in a town of ten thousand and there's four dentists in this deal, these four cups, and so this guy's going to sell. Well, the biggest nightmare would be to sell to some young whippersnapper like you with all this energy and enthusiasm and she wants to be in the parade and go to the schools and do all this high energy sh*t that all the old people like me are like, "Nah, I'm too old and fat, forget it." So, if you just buy this, now you're down to three offices. A lot of these guys started off in a town of ten and then every five, six years some old guy retired and then forty years later that the city of ten now has five and his practice is doing four or five million and plus it's that, with humans it takes a lot of trust in dentistry. Because like me, I grew up with five sisters, so I played Barbie dolls until I was twelve. When the engine light comes on, it's the idiot light for me. The guy's sitting there telling me about my lifters, I don't freaking know what a lifter is. And he's telling me all this sh*t and you just have to have faith. That's what it is, just pure faith. And he's telling me this sh*t, I mean, I have nothing to make it on. So, I always say it to the dealer ... and where I have faith is that the guy who, when I took my car there in 2004, now it's 2018 and the car still works. I've got 150,000 miles on it. That guy's there. When I met him, he was like you, he wasn't married. Now he's got three kids. So, I have faith. And so, when you're selling the invisible, when someone tells you, "Oh, you don't need a cleaning. You have gum disease, you need a deep cleaning." So, I'm just trying to look at you two. Are you lying? Are you a sociopath? Are you genuine? So, the things that are for trust are like, how do I trust you? Well, if every time I come in and get a cleaning, it's a different hygienist, if it's a revolving door, but when I sell my practice, I'm Old Man McGregor and I sell to you and I tell my patients, "I could have sold this to twenty different people, but this is the one I wanted to take over my practice." So, boom, trust. In a small town they say, "Oh, yeah, he retired, and he wanted the younger dentist deal." So, they all come in with trust, they were all referred, and when you're selling the invisible, it's simply a game of trust. When you look at the national data, it's pretty much only about a 38% treatment plan acceptance rate. So, when a hygienist tells three people, "Oh, you've got gum disease, you need deep cleaning", only one and three does it. And they might all have insurance. They're like, "A deep clean? I just want to get my teeth cleaned." So, they either don't understand or they didn't trust. I think M&A activity is amazing. Do you know anyone else in Oklahoma City that's bought three practices?
Howard: And rolled them into one? That's why I was really excited to podcast from here. So, what other lessons have you learned from M&A activity?
Lance: The culture is everything. When we merged the practices together, it required us to take all three offices - two of the three were very, very insurance driven, so they were signed up, they were taking every insurance contract known and they were seeing patients that really valued the price and maybe not exactly the high level of service. They were getting great service, but the value was not what we were trying to do in our own office. So, we knew when we acquired those practices it was more of an acquisition than a merger, because we don't take a whole lot of insurance plans and we're trying to sell trust, we're trying to sell a high level of service, and we knew we'd lose quite a few patients - and we did, but we kept a lot of patients through those negotiations.
Howard: So, do you take Delta?
Lance: We take Delta Premier.
Off Camera: Delta Premier? That's it?
Lance: That's it. Yeah.
Off Camera: So, no PPOs, no Medicaid.
Stephanie: We take them. We're not in-network with them.
Howard: So, you take them but you're not in-network. So, explain that.
Lance: I'm insurance-dumb by choice, so it's someone else's ... this is why I have a great team around me, to explain these things.
Howard: Well, again, you've got a quarter of the audience in dental kindergarten, so they don't even know those terms.
Lindsey: So, even though we're not in-network with most all plans, we're in-network with Delta Dental PPO plus Premier, we file with all insurance companies, so we do receive a benefit from most insurance companies, it just wouldn't be as much of a benefit if they went somewhere else.
Howard: Okay, but explain to a senior in dental school - you're talking to thousands of them right now - what does in-network, out-of-network mean?
Lindsey: In-network is you're contracted with that insurance company and you agree to accept what they allow you to charge. So, you have to write off the difference. Some insurances have very low allowables, which means for a crown, for instance ...
Howard: Give some examples. Like what do you charge for a crown and, if you were in-network for these PPOs, how much would you have to adjust off and accept?
Lindsey: For one in particular that I can think of, their allowable for a crown would be about $560. We charge $1,228 for one of our crowns.
Howard: $1,228? But that's only if they play for the Thunder?
Howard: That's only if they're an NBA All Star? So, you charge $1,228 for a crown. So, one of the insurances you said was $550? So, back to my homies in dental school, when I got out of school thirty years ago, my crown was a thousand bucks and all the insurance companies would just pay a percentage, they'd pay 100% for cleaning, exams and x-rays, they'd pay 80% for root canals and fillings, and half on crowns. And then, over the years it turned into, "No, we're not doing that. We're going to give you the fee." And so, the United States has seen about a 42% reduction in the fee. So basically, for that average $1,000 crown, a 42% reduction would be basically six hundred bucks. She just had an example of five fifty, so that'd be like six fifty. But it seems like what's happening ... and by the way, one of the most confusing things for international viewers and for kids in dental schools is that, the international viewers, they don't realize that in the United States, very few of the laws are federal laws out of Washington DC, and most of the laws that apply to dentistry are at the State level. So, when you say Delta Dental, there's nineteen different Delta Dentals and you can't compare. So, you're thinking of that in dental school, like, "Oh, well, Delta is like McDonald's. Everywhere you go is two all-beef patties, slice of cheese, whatever." That's just total bullsh*t. But what they're doing though, is they're starting to say - and many, many Deltas do that - "If you're not in-network, then just to screw with you, we're going to send the money to the patient." Are you seeing that yet in Oklahoma?
Lindsey: Yes, a little bit, but we're not quite there yet. They do pay to our office. They just pay at a lower percentage, and then the patient is responsible for the difference.
Howard: You know, you're never supposed to talk about religion, sex, politics or violence. So, let's just start with politics. What it is is the liberal mentality has never tried to help you. They always try to control you. Like when you're poor, they didn't want to say, "Well, here's $300 a month to help you pay rent." They're like, "Oh, no, no, no! You're going to live in government housing." And then they're not going to say, "Well, here's a hundred bucks a month to help you with your groceries." No, "Here's food stamps, and they can only buy certain things." And in dentistry, Delta, it's just typical Democratic Party, where they're trying to control you. So, it would be a nice subsidy to say, "Hey, that filling, we donate a hundred bucks towards the filling and if you want to go to this guy who does a silver filling, which lasts twice as long" - I know dentists don't want to believe it because they're completely insane, but one filling is metal and it's half mercury and the other half is silver, zinc, copper and tin silver diamine fluoride, antibacterial, hygienist [sounds like: stainless fluoride] is tin ions. The whole amalgam is anti-bacterial. It's half mercury - you'll never find mercury in a multivitamin. That was a good joke. That was a d*mn good joke and you're just looking at me like ... And then the other one is plastic and inert. If you went behind the dumpster at KFC, to a homeless man passed out on vodka, and said, "What lasts longer? The tooth-colored plastic fork or the metal fork from Momma's drawer?" A homeless man would say, "Well, the metal fork!" After eight years of college he would say, "Well, it's the plastic one because it bonds the tooth together." So, basically, the insurance company is coming and saying, "Here's $100 towards your filling, and if you go to this guy over here putting in metal fillings, where the average silver amalgam filling in America lasts thirty-eight years, that's your choice. But if you go to a cosmetic dentist and you want a tooth-colored filling, where the average one in America lasts six and a half years, we don't care. We're not trying to control you, we're just trying to help you." So, here's a housing allowance, here's a food allowance, they’re not giving you a subsidy so that you can go to General Motors and decide whether you want to apply it to a Chevy or a Pontiac or an Olds or a Buick or a Cadillac, they're trying to control the whole industry, so that everybody's going to get a used car. Everybody has to live in government housing. Everybody has to have food stamps. It's just control, control, control, and so what we're seeing in Deltas and insurance companies now, they're starting to send the money to the patients. The patient gets a cheque for $800, three minutes later they've got a bag of meth and a new bong, and they're on their way to Disneyland, and then by the time you call them on the phone and say, "That's not your money", it's all gone. How did we get on meth and Disneyland?! Insurance. Yes, I think dentists should draw the line in the sand. Here's another thing. Back to politics, what they do is big industry always gets cozy with the government, and the red line in the sand is all the insurance companies can talk to everybody about prices, but if you and I talked about prices, then we'd go to jail. It's kind of like the boiled frog. You put a frog in the water and turn up the heat, and if you don't raise the temperature of the water more than a degree every thirty seconds, you bring the frog to the boil. It has to be a rapid change before his nerves fire and he jumps out. So, it's the boiling frog phenomenon. So, if dentists peaked out in about 2005 at about $217,000 net a year, and they've been sliding down $3,800 a year. Last year was about $174,000. And I don't know how long it will go before they've had enough, because it's a grueling job. I don't know how low it will go before they finally jump out of the pan. So, you're the only guy I know in Oklahoma that bought three practices and rolled them into one.
Lance: I'm sure there must be more.
Howard: But I'm not aware of any and neither are you.
Ali: So, he must be the only one!
Howard: So, you're forty-one. Do you think you'll do it again? Do you think you'll M&A a fourth, fifth, or has your wife drawn a line in the sand and said three's the limit? You've got three kids and three practices in one. Is three the line in the sand?
Stephanie: I learned a long time ago that there is no line with him. If there's a line, he's already passed it, but when you look at, this is what he loves to do. He loves dentistry, but he loves the business side of it too, and he's creative and he enjoys that part of it and that feeds him and drives him, and so I would not ... I've learned long ago that that's not ... yes, he values my input, but I don't put any limitations.
Howard: Nice, nice, fine.
Stephanie: As long as we're still eating! As long as we don't lose our house!
Howard: Your next book, Lance, is 'How to find a wife who has no limits'! But that's one of the hardest things to gauge for a dentist personally. Some people do the sex thing, they'll go in and they'll say, "Well, women, they don't want to be a mom and run an office. They just want to go and be an associate, leave at 5 o'clock, go home and play mom." But that's just too overly simplistic because it doesn't matter what the average woman in America thinks, or the average boy, because whenever you're dealing with someone who has eight years of college and is a doctor ... so, I'll give you another example. Let's say you said, "65% of boys like watching MMA and only 25% of girls like MMA." So, statistically, you might be able to predict the MMA fighters, but the bottom line is when you look at MMA fighters, they're like 99% boys, so it doesn't matter what the average is. So, girls with eight years of college - and it's just going to come down. They always ask me, "If I want to be a good mom, what should I do?" And I say, "Well, it's very simple. You either love business or you don't." Like you love children. I love my four boys. Now I have a lot of grandkids. I love my grandchildren. I sure as sh*t don't want to do a pulpotomy on them? You know what I mean? I draw the line with my love when it comes to a crown! So, what I always tell them, "You've got to look in the mirror, man. Because if you hate business, if you don't have a flair for marketing, if you don't have a flair for leadership, if you don't have a vision and you just want to crawl under a rock and drill, fill and bill, then be an associate." But nailed you right out of the gate that people like us, who like business, it's a creative thing. It's like painting, art. It's just a game, you know? Do you guys like business? Tell me what your views are on business, because you've got three kids.
Kimberly: I have two.
Howard: You have two, she has three. So, she's smarter than you. She has one third the overhead. You should have stopped at one. Ryan's my third child. That's why I always tell everyone to stop the two. He's dead inside, don't worry about Ryan. But anyway, so you had two and you had three.
Kimberly: I had two and so that's why I do not have the passion for business like Dr. Schmidt does. But this is a great role for me because it allows me to do what I love to do, which is work in the practice and help patients, and then on my off time I get to be off and be with my kids.
Howard: So, where do you get your creative flair? Is it root canals, kids?
Kimberly: I like root canal. I really have a passion for trying to make people comfortable in a dental setting because so many people avoid dentists and I feel like a good number of patients have horror stories and my passion just trying to turn that around and make it a comfortable experience.
Howard: I've got to tell you one thing about the horror stories. For the last fifty years, the strongest evidence for a jury was an eyewitness. I mean, if you can get Megan to show up and say, "I saw him stab him, I saw him shoot him." Well, now all the research is in - that is absolutely the worst evidence. They've got all these hidden cameras and they're telling the police, "Yeah, it was a red pickup truck and a white guy jumped out", and you're like, "Okay, dude, the camera. It was a black car. It was a midget." So, I've been a dentist thirty years, I have a patient every six months telling me that in order to get the tooth out, the guy had to put the knee on his chest, and I'm like, "Okay, well, I've never met this one dentist who goes around the world putting his knee on everyone's chest."
Kimberly: He's been in Oklahoma a lot!
Howard: Yeah. So, what I'm trying to tell you is that all people are bat sh*t crazy. I'm probably the only normal person you're ever going to meet in your life. So, all those horror stories, they're all grains of salt. But you just like to get them out of pain?
Kimberly: I like getting them out of pain, yes.
Howard: What does your husband do? Is he in healthcare too?
Kimberly: He's an attorney.
Howard: And what does your husband do?
Marie: He owns a lumber yard, several.
Howard: It's so interesting how all women dentists, their husbands all have jobs. They're all attorneys, dentists, they own companies, and I'm telling the men, they get a lot of creative luxury because when your husband owns a business and is an attorney, you don't have to freaking kill yourself in that dental office, but when you marry the dishwasher at the waffle house who looks really good in a pair of Jordan Dash jeans - what's the new ...? And she had Chanel No. 5 on and she had the front of her hair curled. If you turned her around, there's like a bird nest in the back. I noticed she had the curl thing and the odor thing and the blue jean thing, but I mean, it's just amazing how every time you meet a woman dentist, her husband has a job, is an attorney, is a dentist, is a physician, owns his own business, and then every male dentist says, "Well, you should've seen her twenty years ago. She was so hot, washing them dishes!" So, what's your thoughts on that?
Marie: As I said, my husband does own a family business and I've seen the hard work that it takes to run a small business and I'm just not business-minded and our family couldn't handle two small businesses. So, the associate position is perfect for me in that regard.
Howard: Now does he love the business side of it?
Marie: Well, he does.
Howard: You're not selling me!
Marie: He's selling his business because he decided he doesn't want to do that the rest of his life, and his dad is retiring, but he is a businessman and he likes it.
Howard: Because a lot of people live their life for someone else. Any of your dad's a dentist? Any of you dentists, your dad's a dentist? Some of the most miserable dentists I've ever met in my life, the rock bottom ones, their dad was a dentist, their mom was a dentist, and they just felt like they had to be a damn dentist. And so, their only unique life was to be lived for someone else's life. So many people, and a lot of men think, "Well, if I don't know my own business, everyone's going to think I have a small pee pee, but if I own my own business and I drive a Ford pickup truck that's three feet off the ground, they're going to think I'm very well-endowed", and then they do things that wasn't them. And I always tell people. This is the question they're asking me in dental school. Here's the confusing question when you're twenty-five and under, they're girls, they've got all this massive biology. I mean, what's the only goal of a species?
Howard: Reproduce, have offspring. If you don't drop a frog, we're all dead, right? And so, they're torn. Well, if I drop a frog, I want to be a good mom, what's a better mom? A stay-at-home mom. So, I'm an associate and I just work three or four days a week or I own my own practice? If I just want to be a really good mom, can I own my own practice, or do I need to work for Heartland, Aspen?
Kimberly: I think, absolutely, they can run a business and be a good mom. I think it depends on what your passion is. I think you have to have the drive and the foresight and, just like you said earlier, if it makes you want to crawl under a rock to make these business decisions, then that's probably not for you. An associate or a Heartland or an Aspen or something along those lines might be for you. But if you have the drive, I think, and your creative outlet is to run a business, you absolutely can do that. I have lots of friends who are very successful businesswomen and very successful moms. I don't think one precludes the other. I think we all have, all of us moms have a passion for our kids, so we'll do right by them. So, whatever your passion is outside of your children, that's what you should pursue and that's what you'll be great at.
Howard: I think that's profound advice and also great advice on divorce. I mean, so many people are like, "Well, I don't want to divorce because my kids." Your kids want a happy parent and if you're miserable at Aspen and you're miserable married too Dad, get divorced and start your own business. I mean, what kids want is they want to see their parents happy and they'd rather go visit Dad happy and Mom happy, you know. You only live once and then we all retire to the same size coffin. We only live once. I want to ask you some other questions. Are you the office manager too, or are you mostly doing dentistry? Do you have an office manager?
Lance: Yes, Kenzie is my right hand. We could not be as great as we are without Kenzie's presence. She does so much.
Howard: How good are you?
Kenzie: Apparently, I'm pretty good.
Howard: A lot of people say, half the dentists think this, half the dentists think that, and I always say, "That freaking awesome. Can I see the data?" We have a website, we have a quarter million website, anybody that starts a thread on Dentaltown can start their own poll. Dentaltown puts out polls. So, I've been polling dentists and I've been watching the other dentists polling forever and so I really, really know what they're thinking. I don't have a gut feeling. I mean, guts are filled with sh*t and fecal matter. I don't listen to your ... I don't want to carry your opinion. I want to see data. And if you line up a bunch of dentists and said, "What stresses you out the most?" It's never going to be a root canal. It's never going to be an implant. It's always going to be, "All these people!" They're always going to say, "My staff drive me crazy!" And then if it's not the staff, the next up is the patients. So, basically what dentists are telling you is people stress you out. And when you look at people, what do they do after work? They get in their car and they roll up their window, they drive home and then they open a secret little sliding Batman door and drive in and close it, and then they go in there and all the doors are locked. When you look at people, they all want to be in their own cave. So, how do you manage all these people and personalities and keep it functional and avoid the dysfunction?
Kenzie: Okay, so, I don't do it alone. We have a very great setup. We have team leaders, so even though I might be the executive assistant to Dr. Schmidt, I also have team leaders that are below me. Nicole is the hygiene team leader and then we have Lindsay, who is the front office team leader.
Howard: Which one's Nicole?
Kenzie: Right there. And we have Lindsay, who's the front office team leader.
Howard: Which one's Lindsey?
Kenzie: Right here. And Ebony is assistant team leader, and they help with cascading messages, they help with rolling out new ideas. I can't do it alone. There's no way, because, like you said, it can drive people crazy if you have to manage so many people. We have a very unique system and it works really well for us, just the way we communicate, the teams ...
Howard: Who does the hiring and the firing?
Kenzie: That'd be me.
Howard: Yeah? Okay, so everything you said was all politically correct and nice, you're giving all the credit to everybody. You're up there holding your Oscar, saying, "It was the writer and the director and I was just Meryl Streep. I didn't do anything", but the deal is, I go into dentists, and I always see a sea of dysfunction. I mean, imagine if you were the owner of the Cleveland Browns? I say, "Dude, you didn't win one freaking game. Who picked these fifty players?" And he said, "Well, I did." "Well, you suck." So, a lot of dentists - it's a very important point - a lot of dentists are so miserable with their staff and they don't realize that they're the general manager of the Cleveland Browns. And I say, "Well, who's hiring all these freaking people?" "Well, that would be me." "Well, stop. You suck." And you should be able to see that because seeing your thoughts is everything for a human. Like if you see Tiger Woods and you're like, "I can do that!" and you go out there and you do the drive and it goes to the next fairway, you can see that you suck at golf. And then you see Michael Jordan do the three thing, and every little boy in the world went to do that lay-up slam-dunk and then realized, "Yeah, I bet his mom wasn't a five foot one, fat Irish girl." So, you can see that I'm not going to get into the Oklahoma Thunder. And Michael Jackson, greatest singer in the world. And then I sing, it's like, did I swallow a toad or is that a frog or what the frick happened? So, what does everybody do that they love things where you can't measure it. Like they'll say, "Well, I'm not really good at math. I hate math. I'm not good in science." So, what are they good in? Things you can't measure like art, they're an art critic. They always get into something unmeasurable: politics, philosophy, because when they say, "Well, I'm not really good at math", you notice how they always say, "I'm not good at math," they never say, "Well, I'm not very smart, so I went into art history", they just say, "I don't like math." So, the bottom line is these dentists, you can see your employee turnover and you can track it. I have written several letters to the Federal Reserve where I want this on a stock [inaudible]. Like, when I'm looking at airline stocks, I would like to see how long the average airline keeps their employees. And then, say banking, for me the quickest way to decide if I want to be in Skank of America ... I mean, Bank of America or Chase or Wells Fargo, employee turnover is huge. I don't know why that metric ... and same thing when these dentists are buying a practice. They go into this town, say they go into Norman, Oklahoma, and there's three practices for sale and the average they do is seven fifty a year in collections and the dentist takes on home one seventy-five. Well, these aren't three equal things. What if this office, the average employee's been there two years; this one, the average employee's been there four years; and this one, the average is six years? And you're selling the invisible. These are three different machines. How long have you been on this team?
Nicole: Six years.
Howard: How about you?
Betsy: Five years.
Howard: Five years. And they're both only twelve! That's a pretty d*mn good. They haven't even reached puberty and they've been there five and six years. So, that's all you. That's all you. It's the person doing the hiring and firing, and you're telling me you're miserable, and then the next question out of my mouth is, "Well, how long has your average staff been on your team?" My office manager, Dawn, yesterday just celebrated her seventeenth anniversary. My accountant, Stacy, has been there twenty. Laurie is my Girl Friday - I call her Batman and Robin, others call us Bonnie and Clyde, people who really know us call us Mickey and Mallory Knox - but you can't build a great company when your longest employee has only been there two years. Laurie's been there twenty years, Stacy's been there twenty years, my programmer on Dentaltown twenty years, Dawn, my office manager at Today's Dental, seventeen years. I don't have to micromanage that sh*t. And then people always talk about staff training. Well, I don't believe in staff training. I believe in 'stop your staff turnover'. I mean, if the girl has a job, after two, three, four, five, ten, twenty years, she'll eventually learn it. Some girls will take ten or twenty, some can learn it in two, but the problem is you put them in all this training, you put them in all of these conventions, you take them to all these institutes, and then you fire them, or they quit in a year or two. It just doesn't work. So, if you are miserable at work, the thing you need to ask yourself is, who's hiring all these freaking crazy people. By the way, which one at the table is the craziest?
Kenzie: I don't know.
Howard: Is it a nine-way tie? And what's the most alcohol you've ever drank after work?
Kenzie: I don't drink.
Howard: So, you smoke then? Then the next question they're going to ask is they're going to say, "You know what? When you've got an office and you got three dentists to feed ..." How many operatories do you have?
Howard: Seven operatories for three dentists. You've got to have extended hours.
Lance: We don't have extended hours. Two of us will work, maximum, on the same day.
Howard: Two of you will work maximum?
Lance: I guess the best way to say that is there are two dentists working most days, never three dentists working on any given day.
Howard: You know how many work in my office?
Howard: About half! So, you have three dentists. How many hygienists?
Nicole: Three and a half.
Howard: Three and a half? So, what are your hours then?
Lance: We're open Monday, seven to three, Tuesday, Wednesday, eight to five, and then Thursday, Friday, seven to three. So, definitely not extended hours. It's something we've looked at. We actually tried it in the past. We couldn't make it work.
Howard: Couldn't make what work?
Lance: We couldn't make the extended hours work with the current personnel and patient demand.
Howard: So, let me get this again. It's Monday ...?
Lance: Monday, Thursday, Friday, seven to three.
Howard: Monday, Thursday, Friday, seven to three.
Lance: And then eight to five on the other two days.
Howard: And then that would be Tuesday and Thursday?
Stephanie: Tuesday and Wednesday.
Howard: Oh, Tuesday and Wednesday ...
Lance: No, Saturday hours.
Howard: ... is eight to five. No Saturday. So, that's enough availability for OKC?
Lance: It's enough availability for our current business model.
Howard: Then the next question they're all going to be asking is what's working on patients, what's working on getting enough patients to feed three dentists?
Lance: We have to take really, really great care of the patients that we have and rely on really great word of mouth. We have a ton of Google reviews, average of four point nine. I think we're pushing a hundred and twenty Google reviews total. A lot of Facebook reviews. So, we rely on our patients telling about their experience, either on Google or Facebook or to their friends and family. And we do some really creative marketing as well, external marketing.
Howard: I'm very lucky on Google reviews, because my parents were Catholic, I have five sisters. Between my five sisters and all their friends, almost every I have is a blood relation. They always leave reviews because they get free dentistry. I'm like, "Really? Shelley, I give you a free crown and no review?! Bitch!" That's how you get reviews, just call your sister a bitch. That is very profound because that is something that ... so, a cottage industry is when no single player has more than 1%, and a mature industry is when three, four, five players have 80%. So, you look in dentistry, it's the same as in wheat and corn and soybean. No one guy has 1%. The biggest dental office chain in America is Rick Workman at eight hundred. There's a hundred and twenty-five thousand general dentist offices and there's thirty thousand specialist offices. So, just in general dentists, a hundred and twenty-five thousand locations. You have to have twelve hundred and fifty dental offices to have 1%. So, no one makes 1% of the corn, the soybean, the dentist. And in those cottage industries they are always psycho-obsessed with new patients, marketing, advertising, and they talk about the 'new patient experience'. When you hear someone talking about the 'new patient experience', you would never hear Chase and Southwest Airlines saying, "We want new patients!" If you haven't flown Southwest Airlines - has anybody at this table never flown Southwest Airlines? Has anyone? If you haven't flown Southwest Airlines or gone to Walmart or Target or Coles by now, you probably have a restraining order against you and wear an ankle bracelet. They all talk about the 'customer experience', and they don't talk about marketing, they talk about 'rewards programs' and 'loyalty programs'. Like when I checked in here, the first thing that lady asked me was do I get my loyalty number reports. Same with Hertz Rent A Car. Everybody wants loyalty. And that's so cool how you're really big on the reviews because that's social confirmation to selling the invisible.
Howard: That's why Amazon is taking off so much. Do you realize that one of the core drivers of Amazon is simply the reviews? So, you're a girl and you want to buy this make-up or mascara or whatever the hell girls buy, but you get to see what all these other people are saying, and it just makes all the difference in the world because you just want that review. So, how are you generating so many Google reviews?
Lance: We use a software program and we'll identify patients who might be great candidates to send a review to, either who are tech-savvy, or we know have had a great experience in the past and we'll focus in on them in a morning huddle and say we're going to send them a review, and we do. We send them a text review. They can click on the button, it takes them right to the site. We make it really easy and convenient for our patients to do so.
Howard: And what is that company, what text review?
Lance: They've changed names. They sold. What is it called? Podium?
Howard: Podium. We've done a podcast with Podium, haven't we? So, Google reviews are huge. And then just getting people ... I always say I can smell a successful office in one second, because you either walk in and it feels just like the library and the girl up front slides a window open, doesn't make eye contact, says, "Sign here". And you're like, "Wow. Nice. Glad to be here." You know what's funny about dental offices? They don't realize that ... your hours aren't very available.
Lance: I agree.
Howard: Your hours are very unavailable. A lot of people say the reason Blockbuster went out of business and Redbox took over is because Blockbuster had limited hours and Redbox is open a hundred and sixty-eight hours a week. And that is actually complete bullsh*t, because nobody ever was buying a movie for Redbox and said, "I really miss Sheryl at Blockbuster." When the ATM machines came out, it wasn't just that they're open twenty-four hours a day - and they shouldn't be open twenty-four hours a day. In Phoenix, Arizona, they don't sell alcohol from 2 a.m. to 6 a.m. A friend told me. And when you're at an ATM machine at 2:30 in the morning, withdrawing five hundred, the sign should say, "Howard, just go to bed, dude. You don't need $500 at 2:30 in the morning. You need to go home." I mean, they should close down the bars and the ATM machines at that hour. But the ATM machines didn't take over because of availability, your hours are unavailable. They took over because the ATM machine, you weren't missing the retail experience, because when you look at - and the reason I keep saying 'girls', it sounds sexist, but girls spend two thirds of all disposable income. I mean, go look at your own dad. Who goes shopping, your mom or your dad? Women spend two thirds of all the freaking money. It just is what it is. If you say that's sexism, it's actually algebra and calculus and math, and they call their experience 'retail therapy experience'. I'll give you an example. Look at movie theaters. Every time a new technology comes out, they always predicted the end of movie theaters. Oh, the VCR is going to kill the movies. Didn't. Then the DVD player come out. Oh, that's going to kill the movies. Didn't. Then it's Netflix. It's going to kill the movies. What the problem is, Mom wants to get the frick out of the cave. It's Friday night. She's been in this sh*thole all week and it's called 'retail therapy'. She just wants to get the frick out. She don't care if it's Target, Coles and Walmart. She wants to get out. She wants to go to a movie. She just wants out. That's not going to change a million years from now. The movie. I mean, 1881, they were silent. It took forty years to add sound. And then it's the big screen. It's a drive-in. The VCR. It doesn't matter, the technology. And the dental offices that are crushing it - same thing with beauty salons, their hair lady moves across town and they drive ten miles to go see her because it's a 'retail therapy'. She's like, I just want to get out. My brother is gay. When you have a gay brother, you get a lot of mani-pedis. My brother would say, "You want to go get a mani-pedi?" and it's like, "Whatever." And it's always some Vietnamese chick saying, "Would you like sea salt rubbed on your calves?" And I'm like, "Who the F ever wanted sea salt rubbed in their calf?" I mean, how can you even ask that question with a straight face. I mean, it's like, do you have a head injury? Did your mom drop you? But why do women want sea salt rubbed in their calf? Not that there's some biological reason for this. It's therapy. She just wants out. And who are the people excelling in that? They're ones talking to her about her life and her two kids and your three kids and they're all talking about you - which I find very annoying, because she's down there clipping your toenails asking you five hundred questions and it's like, I don't want to be here. What, are you writing an autobiography? I just don't get it. But the people that are crushing it with the consumers, they have a retail therapeutic environment where they're just like, "Oh, I love it when Jolene cleans my teeth. I love the doctor. I love the front staff." And when they go in there and they just love it and they love the people, it's a $1 million business. But when they're coming in and it’s just transactions, the consumer doesn't really care if you go from Blockbuster to a box. When you're getting your ass kicked by a box, you know what I mean, you kind of suck. And I think that a lot of it is because of the abnormal natural selection of how they chose dentists. They chose all the dentists based on getting As in algebra, geometry and trig. And it's so insanely insane because dentists ... I always tell the story about ... you know the PEW wants to come out with dental therapists, and PEW's completely insane. They're insane. Typical liberalism. They say, we want to come up with a half doctor. So, the first thing you do is you say, "Well, when you get sick, do you want to go to a half doctor?" "Oh, no, I'm going to Mayo Clinic because I'm special. We're talking about half doctors for the little people, the little dumb people that we control. Not for people like me." It was like when Hillary and Bill were against private vouchers for private school. So, then your first of all ask the question, "Well, where does your only child go?" "Oh, private school." Oh, but that's only because you're all that and a bag of chips. But the little people, they need to go to public school. They always have these mixed rules for everyone. And the dental therapists, they say, "Well, you know, the dental therapists, when they graduate, they're going to get on a canoe and go down the river to these tribes out in the middle of the fields and do dentistry on homeless people living in igloos." No, they're not. The bottom line is, you know why these counties don't have dentists? It's because you're accepted on your math skills in math, algebra, physics, all this useless sh*t you never use. So, there'll be a dentist a small town, and he says, "I can't find two hygienists because I'm three hours from Wichita, Kansas." So, I say, "Go to your local high school, have an essay on 'Why I want to be a hygienist', and whoever wins that ... how much is hygiene tuition a year? How much was it?
Nicole: I don't really remember.
Howard: You don't remember because your dad paid for it.
Howard: If she'd payed for it, she'd remember! But it's not that much money. And then, these girls will do the essay and I tell them, whoever writes the essay, they're in. If three people do it, three winners. So, then they apply to the hygiene school and they don't get in, because they didn't have a three point nine five grade point average in algebra and chemistry. So, what they're saying is that a small, rural town, it's better they don't have a hygienist, than a hygienist with poor algebra skills. And so, if you accept the whole class with girls from Oklahoma City, no one’s going to go to a town of two thousand. Jack Dillenberg was the one that proved to the whole world about that. He was the first dean at A.T. Still school and he goes, "The Indian reservations, they don't want a bunch of public health dentists that look like you and me to go down there." He says, "They want to go to Navajos." He said, "Any Navajo that applies to my dental school, I'm accepting them." So, for ten years, what has he been doing? He been sending Navajos back. And nobody's sitting there and saying, "Well, let me see your geometry skills." And if you were Navajo, they have their own language. Would you rather go to a Navajo dentist who spoke your language and looked like you, or to some Irish drunk cracker like me? And who would you trust more? Whose face would you trust more if I said, "Well, you need a root planing and curettage [inaudible]." Pew is completely misguided. They just keep thinking if they just keep exploding the supply, it'll push supply out into the deals, and there are two different mindsets in the world. Country people think the best way to raise a kid is to be in the country where he can go out in the front yard and shoot a .22 410 and ride a motorcycle down a dirt road when he's eight. And in the city, all that sh*t's illegal. Ask me how I know, because I was born in Wichita, raised four boys in Phoenix. I always had police on my driveway, "Your kid was on a go-cart on a main street five blocks away!" I was like, "Did he have a problem with it?" "He was on the church parking lot doing donuts." It's like, "Church is on Sunday. This is Saturday. Why are you anal about everything?" And then you're like, "Dude, it was a .410 shotgun. It wasn't a 12-gauge. It wasn't an automatic weapon. He shot a squirrel." You can go to jail for shooting a damn bird that if you didn't shoot it, it would probably fly into your window the next second and break its own neck. So, if you want rural doctors, accept rural people, but they don't accept rural people. And this is what grosses me out the most. Every time you read an article, California's the worst because they got six dental schools. Every marketing piece from the marketing man will always come out, "So, today USC, would you know, has the highest entrance exam, freshmen, dental class averaging three point seven four GPA. UP was only three six. And those whores at Loma Linda were three point two five. What are they accepting now? Crack addicts?" So, it's that US News and World Report stuff. They're all addicted to having the highest entrance. So, if your metric is having the highest GPA of an entrance exam, because you're too racist to even realize that in the last fifty years there's not one Navajo Indian dentist and there's seventeen different tribes in Arizona. There's nine specialties in dentistry and they always want to tell you about endo, perio, paed, prosth, and they don't want to talk about the ninth one, which is public health. And the public health is, it's the Dean's fault that they're not accepting rural, they're not accepting kids from reservations. By the way, Oklahoma has a ton of reservations. Have you noticed that? I think Arizona and Oklahoma have the most amount of reservations. How many of your freshman class are Indians from the reservation?
Blake: I'd say, none.
Howard: Yes, none. Mighty white of you. Well, it's true. People don't like to talk about it. I call mine Dentistry Uncensored. It's poor public health policy. And the other one that bothers me the most is 8% of emergency room visits are because we didn't do our job and I always tell dentists, "If you can't pull a tooth and you can't do a root canal, give your license to someone that can", you know what I mean? Because otherwise they wake up at three in the morning and go to the emergency room - and the emergency room is also insane because you can go in there, bleeding out your rear end and get colon cancer surgery, they can cut your boobs off, arm off, leg off, cut a lime out of your head. But then when you get to the oral cavity, they're just like, "Well, what do we do?" "Dude, you can do a heart transplant, but you can't pull a bicuspid? Really?" So, its limits. But hey, I just want to tell you, it's so amazing for you guys to come on the show. This show is going crazy viral because they can't listen to radio anymore, because radio's too toxic. No one wants to get on the radio and listen to an hour about Trump and Putin and Benghazi and [inaudible]. I mean, it's just so toxic, by the time you get to work, you just want to give your own self a pulpotomy, and so these podcasts are taking off. Podcast is killing radio! Some of these shows, like the Joe Rogan podcast, the downloads on every show are insane, and they're driving to work or they're on the Stairmaster or the treadmill, and for you guys to come on and share your story and share your journey, I think it was very fun, very informative, and I want to thank all of you so much for coming on today and sharing your story.
All: Thank you.
Howard: The honor was all mine.