An uncensored, unedited interview with the outspoken founder of Comfort Dental, Dr. Rick Kushner
by Thomas Giacobbi, DDS, FAGD Editorial Director, Dentaltown Magazine
Dr. Rick A. Kushner is President, Founder, CEO and
CFO of Comfort Dental, the largest and most successful
dental franchise in the world. He graduated from
Marquette University School of Dentistry in 1977. He
recently made a significant donation to Marquette for it’s
upcoming clinic expansion. Kushner has always advocated
and taught a low overhead, high volume, expanded hour,
bread-and-butter, group partnership concept geared towards middle-income
patients.
When did you transform from dentist to practice
management lecturer and owner of a large group
practice organization?
Kushner: I never made the transformation. It was an evolution in
every sense. I would like to say I had a master plan in place from the
start but I wasn’t that smart and I’m still not. It all happened concurrently
and on a trial-and-error basis. I lectured for about 15 years from
the early ’80s through the late ’90s while I was developing what
became the Comfort Dental monster of today. Comfort Dental has
been in its present configuration since the early ’90s. I only lecture
these days to the Comfort partners and dental students. And of
course, I’m not invited to lecture any longer.
The practice management model that you developed for
Comfort Dental is called “Lean & Mean.” What experiences
outside of dentistry influenced this concept?
Kushner: About a dozen jobs working my way through school
selling everything from ladies shoes to garden tractors must have
taught me a lot. Also, I must have been gifted with a great ability to observe life, a nice dose of street smarts and common sense.
Practice management has always been so simply obvious to
me, yet is clearly so difficult for most dentists. For example,
the observation skill I just mentioned mostly involved
observing what other dentists did and doing the opposite. I
always felt they were doing things so very wrong.
What are your roles and responsibilities at Comfort
Dental? Do you still practice clinical dentistry?
Kushner: First, let me say that I have four of the finest
practice management minds and four of the finest people on
Earth at my disposal full time. Roy Martin, Bruce Irick, Neil
Norton and Mike Bloss are all dentists, have been in my system
for decades, and are minority partners at Comfort
Dental, Inc. They each have special skills and work in different
areas but are all masters of Lean & Mean. I had a personal
tragedy five years ago which obviously set me back but
I am now involved daily and responsible for every aspect of
Comfort Dental. For example, I personally approve all
Comfort Dental locations, meet face-to-face with every new
Comfort partner, and visit each of 100 offices in 10 states at
least once a year. My surviving son Paul is, in effect, our
COO and is involved full-time. He has his master’s (real
estate finance/construction management), is not a dentist
and therefore makes great business decisions. We all have our
hands full helping our 300+ Comfort Dental partners
achieve Lean & Mean practice management. I maintained a
clinical schedule for a quarter century until 2002 and have
not practiced clinically since.
You recently made a generous donation of
$1 million to the Marquette University School
of Dentistry. Tell me about your passion for
this school.
Kushner: First, the donation is a result of the efforts of
all Comfort partners as well as my boss, Cindy Kushner. I
just seem to get the credit. I am a Marquette alumnus but
that is not the reason for the donation. The reason is that the
Dean of the dental school, Bill Lobb, is the greatest Dean
ever anywhere. OK, I’m prone to hyperbole but that’s the
way all of us here at Comfort feel about Bill. You see, Bill
Lobb will not allow his dental school instructors (DSIs) to
criticize outside dentists or otherwise impart practice philosophy
to students. At Marquette, DSIs simply present the
facts of various options, teach students to fix teeth and avoid
denigrating practicing dentists and styles of practice. This
concept, I have found, is very rare in dental schools. For
example, we have seven practices in the Kansas City area
with many more to come. Yet, a DSI at UMKC dental
school has banned me from speaking to his students because
I presented to them honestly the conditions they face upon
graduation and he didn’t like it. I have concluded that the
administration at my local dental school, University of
Colorado, must encourage its DSIs to denigrate outside
dentists and practice styles since they do it so often.
Recently, a DSI admissions interviewer at the Colorado dental
school didn’t even wait for the student to enter dental
school. The DSI criticized us to the applicant and incorrectly
referred to Comfort Dental as “Corporate Dentistry.” So
that’s why we donated to Marquette. DSIs often do great
disservice to their students.
Comfort Dental has considerable experience with
new dentists. What are your thoughts on dental
education based on this experience?
Kushner: I might surprise you by saying that I believe
dental schools generally do a great job under very difficult
circumstances these days. Clearly, our recent graduates (we
do sell lots of partnerships to experienced dentists, as well)
begin their real education when they buy their Comfort
partnership, but most are pretty well prepared when they
graduate. I’ve always said that DSIs could prepare their students
even better if they focused more on achieving more
reps (repetitions) for their students at bread-and-butter
services (single unit crowns, RCTs, non-surgical perio, basic
prosthodontics, amalgam – yes, amalgam – and exodontia,
exodontia, exodontia) and less on imparting their practice
philosophy to them. Likewise, I’ve always believed we’d all be
better off if dentists spent less time worrying about what
other dentists are doing and more time on figuring out how
to provide more affordable primary care services to more
patients in need of care.
The majority of dentists are in solo or small group
practice. Do you think the profession is making
a shift to large group practices to the point
that they will employ the majority of dentists in
the future?
Kushner: Wow! I guess you’re serious. Of course the profession
has shifted. Traditional private practice has been dying
for decades but too many dentists, always late to the party,
don’t know it yet. Prospering in a traditional fee-for-service,
low volume, high fee, high tech, “cosmetic” practice has
always been rare for all but the most talented. Today, it still
exists but only by a miniscule and shrinking percentage of the
most ultra-talented. Continuing Ed today is nearly all geared
towards big fee, high tech, traditional practice and I sincerely
believe it harms far more dentists than it helps. At Comfort
Dental, our dentists average $365K net income before taxes
annually on a 42 percent overhead and most are not ultra-tal ented dentists. We have a good many fine clinical dentists
with great skill sets but they all understand what it
really takes to be very prosperous in dentistry today: hard
work and bread-and-butter dentistry.
What concerns you the most about the future
of our profession?
Kushner: This one is really easy and the most
important thing I can say in this small venue. No contest,
my biggest concern is the tremendous student debt
load with which our graduates enter the profession. Too
many dentists have made too many bad professional and
business decisions for too long as it is. Young dentists with
huge debt make even poorer professional and business decisions
even more often. Like taking jobs in “corporate dentistry”
for $75K (if they’re lucky) because they fear going
even deeper into debt. Thus fodder for “corporate dentistry.”
Eight years of higher education, hundreds of thousands of
dollars debt and they take jobs for $75K. How did all of this
happen? In large part, not enough dentists paid attention to
me for a third of a century ranting about high overheads,
expanded schedules, inefficiencies and fees that were unaffordable.
Now, as much as ever, dentistry is too expensive
and dentists manage badly while trying to perform services
which are out of reach for 95 percent of our population.
DSIs and I probably agree on one thing: corporate dentistry.
Corporate dentistry scares the hell out of me for two reasons:
first, whether they get their money from the public or
from private equity, corporate dentistry will always have
only one priority: demonstrate more profit. (By the way,
Comfort Dental has only one original money source: me.
Oh and a couple of local banks. Of course, every single
Comfort partner is equity invested in his/her own Comfort
partnership.) And secondly, as a dental “chain” we are
unfairly lumped together with corporate dentistry by ignorant
dentists including DSIs and of course, some patients.
Structurally and philosophically we at Comfort are as far
from corporate dentistry as traditional private practice. Had
the profession listened to me instead of attacked me over the
past few decades, the professional landscape would be saturated
with Lean & Mean group type practices so prosperous
that there would have been neither need nor room for corporate
dentistry. So again, how did corporate dentistry happen?
It’s dentists’ fault. It’s DSIs fault. It’s not my fault; it’s
their fault. Dental practices were so bad for so long with
their 80 percent overheads and their hygiene-heavy practices
that businessmen in business suits looked at them and
instinctively knew they could do better and keep the difference
in profits. And guess what? They were right.
Businessmen in business suits looked at dental practice and knew they could handle our business better than dentists. So
they did. Not my fault. I warned dentists but they were
smarter than me. Graduates laden with debt and corporate
dentistry are a match made in heaven.
What is the best thing going for the profession of
dentistry in 2012?
Kushner: I won’t speak for the profession but from our
standpoint here at Comfort, the answer is the same for
2012 as it has been every year for a third of a century. Other
dentists have set the bar so low, chasing five percent of the
market with big fees, it’s really easy for us to do what we do.
I have significant challenges recruiting dentists to invest in
a Comfort partnership and then schooling them in Lean &
Mean management but we do not lack for patients. We’ve
got patients: 50-75 new patients per Comfort partner per
month, month in and month out, year after year. With our
competition being corporate dentistry and traditional private
practice, there is no mystery why we are so prosperous.
Thank you dentists and DSIs. Desperate dental dinosaurs
hang on to the failed ideology of traditional practice with a
(literal) death grip. I’m a Western American History buff.
I’ve read numerous accounts of plains Indians longing to
again live the life of their fathers and grandfathers. How ‘d
that work out for ’em? I mentioned being attacked by the
profession. Before I continue, let me say that there is a
group of dentists I love unconditionally: Comfort Dental
Partners. I love each and every one of them for dedicating
themselves to hard work, bread-and-butter dentistry, all
kinds of patients, and me. Having said that, I must say, certainly
with many exceptions but too often, I have found
dentists to be lazy, jealous, backstabbing, elitist, narrowminded,
arrogant, not very cerebral, and frankly lacking in
character generally. The professional attacks on us have run
the gamut from deeply impolite, to highly unethical,
through grossly unprofessional and even to criminal. By the
way, and FYI: The most vicious of these attacks over the
years have come from hygienists and hygienists cum dentists.
We have been continually sandbagged by neighboring dentists, hated for marketing, advertising, accepting managed
care, our community service, our charity, our branding, our
locations and our fees. We have been treated unfairly by dental
associations, dental schools, DSIs, dental boards and state
legislatures. There is one and only one underlying reason for
our career-long upstream battle with the profession: Dentists
have an elitist bent and can’t or won’t compete with us at our
fee level, our schedule or our work ethic. I’ll admit to being
bitterly frustrated over this and trying to confront these personal,
professional and political attacks historically. Not any
more. For the past five years, I’ve worked hard to take the high
road and embrace the massive differences between the others
and us. I simply try to channel the energy into opening
another Comfort office. So again, thank you, dentistry.
What’s the best thing going for the profession in 2012? For us,
it’s competing with elitist traditional dentists and elitist
corporate dentistry.
What is your legacy for the dental profession?
Kushner: Legacy? I am 60 but I’m on anti-aging and feel
40. Just ask the divine Mrs. K who, by the way is a 30-year old
60 year-old herself. So I haven’t thought much of legacy
because I don’t plan on going anywhere for a long time. I have
been called a genius but here’s how complex my genius is:
“Make it cost less, be open and be nice to people.” There you
have it. I’m a genius with stuff I think I learned in the third
grade but dentists don’t get it. Now let’s get really crazy and
add, “since our fees are so affordable, let’s be well managed and
collect all of those fees at the time of service or even before
service and create 42 percent overheads,” and finally, “focus on
bread-and-butter dentistry.” That’s it! I’m a genius. My first
and only true love is the divine Mrs. K but my passion is
Comfort Dental. This passion gives me something euphoric
every day. Competitively sticking it to this elite profession
using “the kind of patients” they always told me they didn’t
want anyway. My legacy should be the Comfort Dental model.
It should be Lean & Mean Group practices saturating the professional
landscape, which allow dentists to retain the greatest
parts of the profession… maintaining equity ownership in
his/her own practice and management input… while benefitting
from the economies and multitude of other advantages of
our partnership concept. But it’s not going to happen. Not in
this profession. My legacy will just have to be a Comfort
Dental office on every intersection. I realize I’ve just scratched
the surface on a number of topics. I might be persuaded to
write follow up articles to explore these topics further, but you
probably won’t invite me after you see the hate messages you
get as a result of this one, assuming you have the courage to
publish it. On the other hand, they didn’t listen to me before,
maybe this time? Nawwwwww.
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