Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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The Original Zuckerberg with Dr. Ed Zuckerberg : HSP 058

The Original Zuckerberg with Dr. Ed Zuckerberg : HSP 058

3/19/2015 12:37:00 AM   |   Comments: 1   |   Views: 983



Edward J. Zuckerberg, D.D.S.,F.A.G.D. is a 1978 Graduate of NYU College of Dentistry. He owned his own practice in Dobbs Ferry, NY from 1981-2013 and has always been an early adopter of technology, introducing his first PC in the office in 1986 and completely fully networking his home based office with high speed internet access in 1996. Dr. Zuckerberg’s early adoption of technologies including digital radiography, CAD/CAM & creation of a paperless office caught the attention of Industry leaders who enlisted him to lecture, write articles and beta test new technologies. The advanced technology in the home helped launch his son, Mark's, the founder of Facebook, interest in computers. With his wife of 35 years, Karen, a retired Psychiatrist, they also have 3 daughters, Randi, former Marketing Director at Facebook and now CEO of Zuckerberg Media, Donna, who recently received her Classics Ph.D at Princeton & Arielle, who is working for a tech startup in San Francisco as a Product Manager. Dr. Zuckerberg now regularly lectures nationally and internationally on technology integration and Social Media Marketing for Dentists and consults privately with Dental Practices in addition to treating patients part time in Palo Alto, CA. Dr. Zuckerberg authored the chapter on Social Media on the ADA’s recently released “Practical Guide to Internet Marketing.”

He maintains a Facebook Page, www.facebook.com/painlesssocialmedia with tips for his colleagues on promoting their practices using Social Media to attract new patients and maintain and improve relationships with existing ones as well as a page for his patients, www.facebook.com/painlessdrz

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Howard Farran: It is a huge honor today to interview one of my very good friend who I respect immensely, Ed Zuckerberg, and I feel like we have so much in common. We’re both two bald dentists of the same age, we both have four children, we’ve both been loving dentistry for 25, 30- how long have you been doing it Ed? I’ve been it since ’87 when I got out of school. When did you get out of school?

Ed Zuckerberg: Since I graduated dental school.

Howard Farran: What year?

Ed Zuckerberg: ’78.

Howard Farran: Oh ’78 you just look young.

Ed Zuckerberg: So I’ve been doing this for 37 years.

Howard Farran: I thought we were the same age but we’re not. So Ed, before we get into your company, Painless Social Media and I’ve heard you lecture several times. Last time was out in San Diego on your social media. Before we go into that I’m going to start with something- I want to start with this first. I’ve been doing dentistry since ’87, you’ve been doing it from ’78, what advice would you give if one of your kids just graduated from dental school this year. Each year 5000 kids are walking out of dental school. They’re having $250 000 in student loans. A lot of them believe Ed that the glory days of dentistry were in our generation and now it’s being taken over by corporate dentistry. The sky is always falling.

I always step back when people whine about today’s economy and today’s everything and say look, America survived a civil war that almost killed a million people, then they went in to World War one, a great depression, World War two and so now whatever perceived enemy you see is nothing when you look back in time the last 250 years or 10 000 years.

But I want to tell you Ed, what advice would you give your own kid if they just walked out of dental school with $300 000 in student loans?

Ed Zuckerberg: I guess there’s a lot of us out there and there are a lot of obstacles, obviously I think the biggest difference today is the amount of debt that today’s young graduates are coming out of dental school with. We’re getting more people who really are passionate about pursuing dentistry as a career because they love the prospect of being a dentist.

When I went to dental school at NYU in 1978 I found out that an astounding 50% of the class, 100 of the 200 fellow classmates of mine has parents who were dentists whereas I came from, my parents were a mailman and a secretary and I kind of found dentistry on my own as something that might be a nice blend of working with my hands, being interested in the sciences, enjoy working and helping people.

So I think today’s grads are coming out, like you said they’re in debt but they have a passion for this and I think they’re biggest obstacle is not to become employees of insurance companies. So they have to find a niche that will separate them, make their practice unique and stand out from every other dentist out there and create such a loyal bond between themselves and their patients that when the patient changes jobs and goes from XYZ company to ABC company and ABC company has a list of PPO dentists that it supplies for them, that they don’t give the office a call and say hey I see you’re not on the PPO dentist participant list. Thank you for the few years of service you’ve given to me but I’m switching dentists now.

For me it was a recognition early in my career, and this hasn’t changes, that a tremendous amount of patients are phobic about going to the dentist. So they don’t really, they teach you how to do a filling and a crown and a perio treatment and a denture, they don’t really teach you the business aspect of running a dental practice. I think that a MBA would be an incredibly useful skill if it could be incorporated somehow into the curriculum and I know you call your course the one day MBA.

I think that dealing with patients is part of the aspect of running a business that dentists don’t really understand fully, the strategies involved. I was fortunate enough to have my partner in life be a psychiatrist.

Howard Farran: Karen?

Ed Zuckerberg: Yeah, my wife Karen, and I said hey I’ve got this issue. People don’t like coming to me. If I’m going to be successful and make this transition from tooth driller to their confidante and their person they trust, their oral health for the rest of their lives, I’ve got to conquer this. So we developed a lot of different strategies. We adopted some branding, the whole painless things, learning really goo anesthetic technique and really following through on delivering care painlessly and really taking the time to explain to patients what the treatment was all about and obviously it worked, because when we did have a few patients make necessary changes for financial reasons that they had to, to go to another office, it wasn’t long before they came running back and saying we really see the difference in care once we left Dr. Zuckerberg’s office and will you take us back?

So I’ve always had an open door policy for every patient that left the office and I think the biggest problem with today’s dentists is that we’re not really educating patients and showing them the value that our practice brings to them that differentiates us from our colleagues.

Howard Farran: Ed I thought it was, well I thought it was interesting that you said the biggest fear going forward is that they don’t become employees of insurance companies which is profound and you didn’t say that they don’t become employees of corporate dentistry. You and I loved through, when we got out of school back in the day there was a first round of corporate traded practices. Remember Orthodontic Centers of America? The only one that made it to the New York Stock Exchange and then that exploded and when I got out of school there were a dozen on NASDAQ and every one of them disappeared and so are you thinking that the bigger dilemma is working for the insurance companies and not corporate dentistry? What are your views on corporate dentistry? Do you think they’re going to double in size? Triple in size? Stay flat or go away?

Ed Zuckerberg: You know we all have to make decisions of what we want out of our practice and out of our lives with owning our own practices, either solo or with a couple of other dentists, colleagues or maybe even 10 person or a large group, some of the decisions we make are what kind of lifestyle we want. Do we want to have the responsibility of always being on call? Going away on a ski trip with the family over the weekend knowing that the phone is going to ring and you may have to deal with it.

After hours emergencies, things of that nature, running the business end of the practice in addition to the clinical end of the practice, if that’s not for you then certainly some form of group practice, be it mega group or just a group of three of four other people with shared call and shared financial administration of the practice and the difficult decisions of running a practice like hiring and firing staff and setting policy and things of that nature, solo practice isn’t for everybody.

Yet, for me, if I had to do it again that was the way I would do it. My practice was so solo that I ran it out of my house for 33 years, you don’t get any more solo than that.

Howard Farran: And that’s interesting Ed because what you did is actually illegal in most states. Most states health departments will not let a dentist live in their office and as an American who has been to 50 states, you only see that in the Northeast where Ed, for those who don’t know, he lived in a three story house. The first floor was a dental office and then they lived on the second and third floor, correct?

Ed Zuckerberg: It was a split level home so the dental office was adjacent to the family room but it had it’s own separate entrance on the side of the house so it was kind of like attached to the house but not part of the integral living space of the house and I’m not familiar with the laws in all the states in the country but in New York anyway, the only requirement to run  a business from your home is that you had to occupy the home as your primary residence. So in my case, or the case of a lawyer, accountant or medical physician or anyone who wanted to have an office in their home where patients or clients came to visit them in their house, the only stipulation made by the state allowing this to go on in a residentially zoned area was that you had to live in that house.

So that kind of prevented a dentist or another professional from buying a house in a residential property and turning it into a business and living elsewhere.

Howard Farran: So it’s interesting because if you go around the world, most countries, especially Asia I would say, most people in Asia live in their home. In fact, Chipotle after 17 years of doing Chinese food they started their own Chinese restaurant. They’ve done the same thing with Chinese food where the average Chinese restaurant has about 50 items on the menu, they’ve got it real slimmed down, about seven items and they started it in Washington DC and they’re calling it ShopHouse because in Asia, Chinese food, most shops are on the first floor and everyone lives above the shop so they chose that name ShopHouse.

Ed I want to ask you another thing before you get into social media where you obviously genius out there, way ahead of the pack. Back to this debt, you’re saying the major difference is these kids come out of school with more debt than we did. Did you have any debt when you walked out of school?

Ed Zuckerberg: Minimal. I think $20 000 after three years of dental school.

Howard Farran: So Ed, a lot of these people come out with $200 000, $300 000 in student loans.

Ed Zuckerberg: I’ve heard numbers of $500 000.

Howard Farran: But then they face even bigger decisions. Ed I know you’ve always been very much into high technology. I would call you a very high tech oriented dentist. Do they need to go another $150 000 into CAD/CAM? Do they need to go another $150 000 into 3D x-rays, CBCT? Some of these lasers out there are $50 000. Can these young kids coming out of school, can they be a high tech dentist and not have a CAD/CAM and a CBCT and a laser?

Ed Zuckerberg: You can be but those things shouldn’t be barriers if you used them in dental school and you’ve evaluated the technologies and you’ve found that these are useful practice items for you. They should not be financial barriers and the technologies that I’ve examined in my earlier courses when I first started lecturing back in 2010, 2011, a significant part of my lecture was about integrating technologies into the practice and learning how to evaluate whether a piece of technology made sense financially.

So let’s take for example CAD/CAM. We bought our E4D CAD/CAM in 2008 for I think the actual purchase price was about $125 000. If you’re fortunate enough to be able to afford a car for that money or any big ticket item for that money, you’re not dipping into your checking account and writing a check so it’s not necessary for a young dentist to have to get an additional $125 000 in funding. The way the deal is structured is you’re leasing the equipment from the company, or there’s a leasing arrangement made with the company and the technology has to make sense in terms of generating income for the practice that exceeds the cost of the lease payment so adding these kind of technologies are not financial burdens but rather they are profit centers for the practice.

The lease payment for a CAD/CAM, I don’t know what it is crunching today’s numbers but back in 2008 it was about $2 200 a month for me and the cost of the block and the burs which were the only basically expendable items per case, probably came to no more than $30. So if you add the cost of delivering a cast restoration or a crown or an inlay or veneer to a patient, there’s a multitude of costs involved including the extra time for fabricating a temporary that’s saved, the extra visit for the patient having to come back and all the disposables and costs of appointments, the laboratory fee, impression material which is now bypassed by scanning, so I actually found that my real cost for delivering a laboratory type service amounted to about $300-$400 per patient.

So if I’m saving about $300 per tooth on utilizing this CAD/CAM technology, I’ve got to do a minimum of seven restorations a month to break even and we were doing easily double that so this became a profit center for us. I’m not saying every single piece of technology is that easy to figure out.

I remember when I was the first kid on the block, back in 1998 to put digital radiography in my office. I remember the questions my colleagues were giving me because they didn’t understand this new technology. They’re going like Dr. Ed, are you going to take more x-rays? And I said no, I’m just going to continue taking the same number of x-rays I always took with the digital technology. And they said well are you going to charge your patients more per x-ray? I said I don’t think that’s going to be necessary at all and they would scratch their head because in 1998 it was about $15 000 to put a simple digital system into your office and they’d want to know how I’m going to justify that kind of expense, how I’m going to recover that kind of expense and I said, to me, and I guess a lot of these ROI decisions go right through my head. One of my biggest challenges in practice was converting what I know into an accepted treatment plan for the patient and the tools that we had available to us prior to digital x-ray were intraoral cameras which are a great tool, I mean you could try and show a defect but a lot of our defects are under the surface so x-ray was like one of our biggest visual tools that we had, yet here we are taking the patient out of the chair, bringing them over to a little view box, making them squint at a tiny x-ray and being so dramatic about showing them what’s there and they really can’t see it, so we’re really not getting the message home and as a business man, we’re essentially when we’re selling our treatment plan we’re competing for free capital expenditures on the part of the patient that, in many cases, we’re competing with the new car that we need or the vacation that they want to take and they’re not interested in hearing about this multi thousand dollar treatment plan we’re throwing to them because we haven’t succeeded in showing them the need.

Now fast forward to having a 21” monitor mounted on the chair and you take this x-ray that appears instantly and all of a sudden this one lesion on a tooth is blown up the entire size of the screen, you can even colorize it or whatnot. It looks like they’ve got cancer in their mouth or something, which essentially they do, with a large caries lesion or whatever going on, and now they can’t schedule that appointment soon enough.

To me it’s like one of those Visa or MasterCard commercials, where it’s $3 for this and $10 for that but the ability to spend an incredible vacation with your family is priceless. You can’t measure in dollars the increase in treatment plan acceptance that you get with a digital x-ray, so there are some technologies, but then again thinking on the terms of cost recovery, I’m sure that the amount of money that I’ve saved in not buying film and not having chemicals that are constantly changing all the time has easily many times over paid for the cost of the digital x-ray machine, plus what about the time, you’re doing an endo or whatnot and you’re waiting for a measurement x-ray back or you’re doing a treatment plan on a new patient and you’ve got to wait for the assistant to develop the x-ray and you’ve got 10-15 minutes waiting for the x-rays to be developed and mounted that you’re sitting there schmoozing with the patient about their sick dog or their last vacation instead of actually getting right into getting productive immediately after exposing the x-ray.

So every technology has it’s place and every technology, from a financial standpoint that a dentist is going to put to place in their office should not be a financial burden but rather should be a financial support for the practice.

Howard Farran: I think it’s interesting how if you walked into 100 dental offices and go to, you know, at least half the dental offices run off just three software’s, Dentrix from Henry Schein, Softdent, EagleSoft from Patterson and Softdent owned by Carestream and if you go in there and run the report generator to see what their treatment planning acceptance rate, the report has never even been ran and I think you nailed it with digital radiography. The average case acceptance in the United States for a dentist is 38%, so if they diagnose 100 cavities, they only drill, fill and bill 38 and they want to talk about their filling techniques until the cows come home, and it’s like dude, you didn’t even remove the cavity on two out of three.

I’d rather dentistry just removed all the decay and filled it in with temporary Elmer’s glue or saw dust and coconut oil, I mean anything, they don’t even remove the cavity two out of three times and I think digital radiography, I think when humans see the cavity, and you said it best, intraoral camera shows above tissue and the digital x-rays is the whole tissue.

In fact I think what’s greater than the CBCT was on the two dimensional pano, whoever invented the L and the R, you know. I mean it’s just one picture, all the teeth, the patient sees that R, knows that the right side, gets oriented and then you show them the cavity or the impacted wisdom tooth and they get it and they buy. So those are priceless. Ed what other technologies do you think these young kids need to think about or what they should have their eyes on? How should they wrap their thoughts? You talked about digital radiography, you talked about CAD/CAM, are there any other technologies you think they should be thinking about?

Ed Zuckerberg: I mean it’s different for every dentist depending on the type of practice they want to run.

Howard Farran: Is that Karen?

Karen Zuckerberg: Yeah hi!

Howard Farran: Hi Karen!

Karen Zuckerberg: I’m just leaving. How are you doing? 

Howard Farran: I’m doing good, we’ve got to do dinner again someday, that was fun having dinner with you. Hey Karen I’ve got to ask you a question. Could I ask you a question Karen?

Karen Zuckerberg: Yes but I’m running out.  

Howard Farran: Okay just real quick, do you guys know Tarun Agarwal? He’s a dentist in South Carolina, teaches CEREC and Implants? Big Indian guy, everyone calls him T-Bone?

Ed Zuckerberg: Can’t say I know him.

Howard Farran: His wife is a psychiatrist too and I had dinner with them one night and it was kind of like the dinner with you guys where both wives are psychiatrists married to dentists and they both think dentists have some unique psychiatric issues and I think a podcast with you and or, I don’t know if we can do a three way Skype but get T-Bone’s wife, I think that would be interesting having two psychiatrists married to dentists and the only question I’ll ask you is if there’s anything unique about the dentist’s brain?

We’ve heard things that we have a high suicide rate, we’ve heard- everybody has things but you’re a doctor. Would you ever be interested in doing that podcast?

Karen Zuckerberg: Sure we can do it. Let me give it some thought.   

Howard Farran: Would you want to do it just you and me or would you want me to get the only other psychiatrist I know married to a dentist which is T-Bone’s wife, Mrs. Agarwal?

Karen Zuckerberg: Definitely, the more the merrier.

Howard Farran: Can Skype do three way?

Ed Zuckerberg: Yes.

Howard Farran: It can well Ed and I will figure out the three way.

Ed Zuckerberg: You might need to step up to like a GoToMeeting or something like that.

Howard Farran: okay well we’ll figure it out. I want to do that because dentists are always asking other dentists, is it true we have the highest suicide rate, or some people think dentists are crazy. Do you think dentists are crazy? And I say well they’re probably a little ADD or a little- I’m sure you have a lot of thoughts because how many dentists have you met, being married to Ed, in your lifetime, how many dentists have you met?

Karen Zuckerberg: Oh quite a few.

Howard Farran: What’s quite a few? All the meetings you’ve gone to, all the dental lectures you’ve gone to?

Ed Zuckerberg: You don’t get to meet people very well at meetings but a fair amount of our friends are dentists.

Howard Farran: Well if you ever want to do that Karen I think it will be a great podcast. I bet it will get more views than probably anything we ever do.

Karen Zuckerberg: Well sounds great. I have to run. Take care, good to see you.

Howard Farran: So Ed, we’re asking is there any other technologies that you think?

Ed Zuckerberg: I mean again, it’s different for every dentist and practice. Some dentists, and I’ve tried lasers and didn’t- found minimal incorporation into my practice and my hands but there are dentists that swear by their laser, they use the laser for everything. I like to see direct and I like the patient to feel me looking directly in their mouth and at them so for me, microscopes didn’t work but again I’ve got colleagues who swear that you can’t perform the highest level of dentistry possible without using scope.

That’s great. I always focused on, from a business and marketing perspective, so I was an early adopter of things like air abrasion. I remember always looking for ways to deal with kids and so simple class ones that wouldn’t hurt a five year old child and things like that and I remember the, my assistant, my office manager of 25 plus years had an occlusal lesion on number 18 and I didn’t actually realize how deep it was. I remember just taking a peek in her mouth and saying yeah let’s take care of that one of these days  between patients or something like that. We were a little lax in getting around to it and I called in the guy from the air abrasion company that was pitching to me to demo in my office and I sat her down in the chair and I’m zipping away with this air abrasion and the thing is opening up and I’m going oh my God this thing might be an endo here, and I haven’t given her any Novocaine and she wasn’t flinching or anything and I eventually cleaned the whole lesion out and it was quiet and she looked up at me after about 30 seconds and said when are we going to start and I looked at the salesman and said I’ll take it.

Howard Farran: Was that the Creative Air Abrasion, was that the name of the original one back in the day?

Ed Zuckerberg: Yeah it was a huge monster machine. So that technology, I was always a big one for digital so people nowadays can’t relate, maybe you and I can but people nowadays think of computers as indispensable items in the office. Back in 1985 when I put my first computer in the office, the IBM PC XT which had a 10 megabyte hard drive and 512k memory, not enough memory to hold one of today’s pictures on a digital camera. It was ridiculous and these were the tools we were using to do our bookkeeping and our practice management and again, I was on the cutting edge. Most dentists, it was at least mid 90’s until dentists started to put computers in their practice.

By the mid 90’s we had paperless appointment books with networked computers in all the operatories.

Howard Farran: I got to add one more thing to that, remember the big Y2K? The kids out there now probably don’t remember but back in the day, the computers to save space, they only had two digits for the year, so when 1999 was going to turn to 2000 the computer would think it was the year 1900 and so the Fortune 500 was doing a mad scramble to update their software and computers to go to a four digit and every dentist I know in 1999, said that’s another reason I’m glad I don’t have any computers. In ’99 I didn’t know really anyone who had a computer because that Y2K was crystal clear.

Ed Zuckerberg: Yeah we had our own little amusing story with that. My wife is a little bit of an alarmist and she had a lot of spam and batteries and stuff like that in the house expecting the end of the world and my kids were a little bit smart Alex and as we counted down at the exact moment of that the clock struck midnight, I think it was probably my son but I’m sure my oldest daughter was also a collaborator, flipped the main circuit breaker in the house so we had a complete blackout in the house.

Howard Farran: That’s classic!

Ed Zuckerberg: And my wife goes see I told you! I told you! You didn’t believe me! And about 10 seconds later the lights came back on.

Howard Farran: Would you call yourself a bleeding edge technology lover or a leading edge? Where do you draw the line between bleeding edge and leading edge?

Ed Zuckerberg: I would consider myself leading edge. I think a bleeding edge is probably someone who adopts anything that’s out there left or right and probably makes more mistakes than they pick winners on. I think for me it’s got to make sense from a return on investment perspective unless the technology is so amazing that there’s no way to recover the money but it’s going to really improve the quality of care I can give enough.

I mean I’ve yet to be convinced by, I’ve looked at technologies that help dentists detect oral cancer. Being a VA dentist and doing my VA residency when I first got out of dental school, I was actually on a team that helped prepare the oral cancer examination video series for dentists that was distributed throughout the whole VA network system in the late 1970’s so I’ve always been very focused on doing oral cancer evaluations significantly and even though I’ve only found five or six in my career, that’s probably five or six people’s lives that I’ve had a significant impact on. It was certainly worthwhile.

I’ve looked at the technologies out there that supposedly help us detect these things more easily and first thing I realized is you’re not going to charge a patient for it and you’re not going to get reimbursed so this is clearly a loss on investment but if you can detect one cancer with this thing it’s worth whatever money you spent on it.

So there are certain technologies that don’t make sense from a financial point of view, but they probably should be in the office anyway but for the most part, it’s got to either make sense financially, it’s got to improve the way I deliver care, it’s got to make the patient experience better, it’s got to allow me to deliver a higher level of care to the patient.

And enough winners out of that group is what it’s going to take for me to implement the technology in my office and it’s going to be different for every dentist, which technologies they choose to employ.

Howard Farran: And I just want to add one more thing that your wife Karen might agree with being a psychiatrist and that is: laser, I always joke. Laser, does it stand for what the physicists say, light amplification stimulation emission radiation or does it stand for what the nay-sayers say, that laser stands for losing all savings equals reality. The one thing I’d like to remind, we’ve both raised four kids and a lot of times over the years dentists have come up to me and say: Howard, do you think I should buy a laser? And I’d always say well what do you think? And they’d go if they said oh I just think it would be really, really cool. I’m like then you have to buy a laser, because if my four boys were in the sandbox, if I threw in some Tonka trucks and shovels and pails, they’d stay in there all day but if I took out all the toys out of the sandbox and the bathtub they just wanted to get out. A lot of dentists having a burnout, they get tired of doing the same thing for 40 years and I always say if you think a laser or some technology would just be really cool and it would make you run 30 red stoplights on the way to work and get a speeding ticket because you want to go play in your office all day then you can’t afford not to have it. We only live once, go and have fun.

Ed Zuckerberg: In the 90’s when I looked at the laser technology and the price tag was pretty big, it was like $40 000, and I’m not talking about the table top ones that you can get for $2 500 or $3000 now that I think are really valuable tools in preparing the margins for your crown preps and things of that nature, I’m talking about the older ones that were huge boxes and if you’re going to plunk down 40 grand, you better look at that monthly payment that you’re going to make on that machine and figure out where the revenue is going to come to pay for it.

For me, it didn’t work for hard tissue which was the biggest thing I wanted to evaluate, was this an option to what I was doing already which was either using a hand piece or in some cases using the air abrasion and the answer was no, it didn’t make sense for me so I didn’t implement it.

Howard Farran: So Ed, how did you get into social media?

Ed Zuckerberg: Well so- I was an early user of Facebook obviously, my son’s company which was formed 11 years ago last week.

Howard Farran: 2005 was it?

Ed Zuckerberg: 2004, February 4th and about four years later, in 2008 Facebook opened up pages for business which was a separate tool than the profile pages and we understand this well, you and I, because I think back in 2010 when we had a chat about five years ago, you had a personal page that you were using for your business and I think you reached out to me because you hit your 5000 friends limit.

Howard Farran: And I didn’t even know there was a limit until I hit it.

Ed Zuckerberg: Well there was no limit on business pages but you didn’t realize about the existence of the business page structure which most dentists did not, so I decided after that interaction with you that I really needed to be the spokesperson for dentists out there to let them know that here’s this great tool for promoting your dental practice that you’re not using that you should be using that’s going to do away with 90%+ of what you’re doing in print and it’s going to allow you to kind of espouse the kind of practice that I’ve always advocated since I’ve first been in practice, one that enhances the bond between the dentist and the patient so a lot of people think of Facebook even today as a way to drive new patients to their office.

I think the most valuable component of a Facebook page for a dental practice is for internal marketing, is to allow you to really cement the relationship between your existing patients. Let them know what’s going on in your practice, let them know about the amazing technologies you’re employing and then at the same time to get them to utilize more services more frequently and feel a better bond connection to the office, another way to reach out and connect with the office, to get their questions about their visits answered and then the external marketing part comes in because the tool allows you to advertise and promote your page out to their friends in their network who aren’t already aware of or fans of your dental practice page.

The average user on Facebook, unlike you Howard who has 5000 fans, the average user on Facebook has a personal network of about 300 friends. Still, if you get as few as 300 of your patients to like your page on Facebook and each one of those has 300 friends, you’ve got a potential market of 90 000 people who you can actually promote a word of mouth referral to.

Howard Farran: But I want to go back to something, I just want to highlight something you said is very profound, I agree with you that most dentists think of Facebook as external marketing to get new patients in and you said the opposite. You view it as more internal marketing and I’d like to remind dentists something that they don’t think of. They’re always talking about trying to get new patients in the front door and they never talk about losing all their existing patients and if a hygienist worked 40 hours a week, 50 weeks a year, we’ll give her two weeks vacation in a year, she would work 2000 hours. That means she could see 1000 people like me and Ed twice a year for a six month cleaning and if you’ve got 25 new patients a month, you would be adding a another full time hygienist every three years, but you go to these dental offices and basically for every time they get 10 new patients in the front door, eight or nine of them have fallen out the back door and if you could go to Colorado River and you put a dam up here in Northern Arizona, it backs up that river, it’s one of the biggest lakes in the world and too many dentists have their back door wide open while their front door is trying to get all these new patients in and you’re saying use social media to keep your existing patients in, which is basically shutting the back door. Try to keep retention.

So Ed, specifically, how would you use your Facebook business page to retain your patients? To keep them staying with you instead of forgetting about you and a year or two later thinking oh I need to get my teeth cleaned and going back to Google or the Yellow Pages and just trying to go to a new dentist on their list?

Ed Zuckerberg: Well it starts with getting them to like the page. So that’s the biggest leap and we teach a number of different techniques for getting your existing patients, and people who aren’t even patients of the practice to like the page. Without the likes you have no audience. So any efforts you make are worthless. If I draw the comparison to movies that are coming out. Let’s say this week, what’s coming out this weekend? Fifty Shades of Grey is coming out Friday. A lot of people have heard in the marketing that this movie is coming out this Friday.

Howard Farran: I thought it was about radiology. I thought it was about an x-ray. 50 Shades of Grey.

Ed Zuckerberg: 1000 Shades of Grey. That was actually a marketing campaign for DEXIS and I was actually at one of their roll outs a few years ago in San Francisco and I don’t think the developer of the campaign was aware of the book and I said maybe you’d want to rethink this strategy.

Anyhow, movies now they all have their own website. There’s a tremendous amount of advertising that starts sometimes as much as a year before the movie comes out and then ultimately the day the movie comes out you know there are going to be long lines and sellouts and they’re going to be the number one box office hit that weekend and hopefully for many weeks thereafter. Of course many weeks thereafter is going to depend on how good the movie is and whether people tell their friends and say you’ve got to see this.

Same thing goes with a dental office. A lot of people focus, the key to a successful dental Facebook page is having great content. I’ve seen offices that have phenomenal content but they’re not telling people that their page is out there and so it’s falling on deaf ears and blind eyes. No-one’s seeing it and finding out about the page. If someone opened a movie without doing any pre-marketing about the movie, well the Friday that the movie opens would come along and there would be no one buying tickets because no one knows about it.

So the first step is to get people to like your page.

Howard Farran: How would you recommend specifically a dentist?

Ed Zuckerberg: You’ve got to go about it using a myriad of techniques. The best way if with in-office techniques because the people who are in your office already, theoretically like you as a dentist, as a dental practice, you are their dental practice so making the conversion from the office should be the starting place and obviously signage to let them know to join the Facebook page but perks are important too.

So you’ve got to give them some incentive, why should I join this page? Maybe it’s in the form of winning a contest. Some offices I know will give away like a free Mini iPad every month and they’ll have a draw from all their fans to give out an iPad so if you’re not a fan, you’re not in the running for a drawing.

Other offices will do other kinds of promotions that are available only to their fans. Two for one bleaching at Valentine’s Day. Come in this month and get your teeth bleached and get a free certificate for bleaching for your sweetie, something like that. A lot of incentives to try and drive people to like it. Once you get them to like your office page, now you’ve got to keep them with good quality content.

So it’s a twofold approach; driving new likes and keeping them and motivating them with great content.

Howard Farran: What do you think of- page boost or Facebook ads? If you were in a town, Parsons, Kansas, would you buy a Facebook ad, because I know on Facebook you can type in the city and it will tell you how many people the reach is. Do you recommend buying ads for likes? Do you think that’s effective?

Ed Zuckerberg: Absolutely. So there’s a number of different ways to use advertising dollars to promote your office Facebook page. One of them is simply to promote page likes. Page likes is a way to basically grow the number of people who like your page and what Facebook is doing is they’re letting you set your own budget. For many offices it’s $5 a day, so minimal expenditure of about $1 500 dollars a year, so that’s- even if that gets only a handful of new patients in each month or a handful of new likes for your business each month, that’s valuable source of marketing.

People that you can market to, many of them are not going to be patients yet.

Howard Farran: So Ed Specifically, you said $5 a day? Go through the specifics of what that means because on Facebook sometimes it says boost this post, or this post is performing better than other posts, would you like to boost this, and when you’re saying $5 a day, is this something they need to go click and do something every day? Can you just set it up one time and it will always do it? Can you go into specifics?

Ed Zuckerberg: Whoever the administrator is for a business page, and a business page can have multiple administrators, so a dentist might run their own Facebook page. They may set it up or they may drop it out to an outside agency. In any case they can always have staff members who they can allocate administrative privileges to. Remember to remove them if you ever fire the staff member.

So anyone who is an admin of the office Facebook page has the ability to post direct content and to run an advertising campaign. So from the main Facebook page, if you are logged in as an admin of the page, one of the options you’ll see on the upper left section of the page is the ability to promote the page and what that means is you’re going to basically pay for an ad that’s going to send a marketing message, and you can use, you can select which photos of your business and 100 character or so blurb of text that you want in there about what makes your office unique and it’s going to be in for form of an ad that’s either going to appear in the right hand column of people’s news feed, their home page where they read about everything going on with their friends and other pages they’ve liked, or it might actually be embedded in the news feed as what we call a sponsored story. You’re allowed to pick your daily budget so it can be as little as five bucks, it can be 10 bucks, 15 bucks. The amount you pick is going to depend on how aggressive you want to be and also how big your city is and your marketing area so you can also pick zip codes where your message goes to. 

Howard Farran: Oh you can pick zip codes instead of just cities? Is that a new feature?

Ed Zuckerberg: No, that’s been around. And obviously if you’re in a big city like Manhattan that’s really important because whereas if you’re in a rural area, you might be marketing to a 30, 40, 50 mile radius. In Manhattan, your practice profile demographic may be half a mile radius around your office, people who can walk there from work or something like that.

Howard Farran: And just for our viewers, you’re up in Dobbs Ferry your whole career. That’s about 10 minutes from Manhattan?

Ed Zuckerberg: It’s a little over 20 miles from midtown Manhattan so it’s about 30 minutes on Metro North, on the railroad by car with traffic it’s probably about 40.

Howard Farran: Your area is very different than Manhattan right?

Ed Zuckerberg: Yeah Dobbs Ferry was, even though we’re only 15 minutes north of the New York City border it had a suburban feel to it so it was kind of like anywhere USA. Malls and shopping malls and you know lots of mostly private homes and things of that nature.

Howard Farran: So Ed, more specifics. What is your expert opinion? I don’t think there is a dentist on earth that knows more about Facebook than you. Should the dentist do this internally or should they use a company? Because you see advertisements for companies that will manage your Facebook page for a dentist. What are your thoughts on that? What should a dentist be thinking, because we were trained in root canals, fillings and crowns not marketing and advertising? What are your thoughts on that?

Ed Zuckerberg: I think it’s really important for the dentist to be involved in their own Facebook page and staff members too so that whoever is generating the content for your page, one of the best starting point entries for Facebook page for dentists is likeable Dentists, which was a joint effort between Likeable Media and Henry Schein and for as little as $2000 a year I believe dentists can get, Likeable will set up the page for them and they’ll also put content up on a daily basis and do a little bit of promoting as well.

Howard Farran: So you do recommend a daily post? Because some people are worried that they post too much and be spamming, some post too little, what is the optimum number of posts?

Ed Zuckerberg: It would actually be multiple times daily because you have to understand that very few of your posts are being seen by your patients and the fans of your page. There is what we call the generic reach of a post, which is approximately only 5% so if you’ve got n audience of even 1000 fans on your office Facebook page, if you’re not paying to promote your content and boost your post, you’re generic rate of being seen by your audience is probably only going to be between 50 and 100 of those 1000 people. Now that’s going to be further modified by how good the content is.

So Facebook doesn’t have the manpower to sit there and read every one of your posts and evaluate whether something is desirable, so instead what Facebook does, they have an algorithm that can measure engagement and then only kind of engagement they can measure is whether someone clicks on a post to say they like it, whether they click on the comment feature and write something in response to the post or whether they share the post or in the case where your post actually provides a link to an article that’s hosted somewhere else on the internet, if they click on the link to follow the article, Facebook can measure that too.

So those are all engagements. Now you might be putting great content out on your page that people will look at and read and go yeah, that’s valuable, that worthwhile, if you don’t get that click, Facebook doesn’t know that your content is worthwhile and let’s face it, Facebook is a publically traded company. They need revenue and they way they get revenue is they sell advertising. They don’t charge the subscribers a dime. So the heart of the Facebook ecosystem is the news feed. This is where, when you log on to Facebook, you’re taken to as your starting point and this is where you read all the posts that you’re- people who are your personal friends in your network tell you what’s going on in their lives or stuff they think is interesting. This is where the businesses like the dental offices or the newspaper or the brands that you like are putting up what’s new about their content, their new products and stuff like that and with 1.4 billion personal users and 100+ million businesses on Facebook now, there’s a lot of competition of new status updates going into the average user’s news feed.

So they can’t see everything that everyone is posting and Facebook wants the best content in there. They want the stuff that’s getting the most engagement because the better the content is, the longer the users who are there will stay on there, reading stuff. If you’re posting about what you had for breakfast, nobody wants to know that and that’s boring and that’s going to cartel the amount of time they spend on Facebook.

So good content that gets engagement from the users or paying for it. That’s the two ways you’re going to get your content to be seen. Dentists really need to pay to boost their posts and again, the budget does not have to be sizable compared to what I used to spend on having a full page Yellow Pages ad in the Yellow Pages and being a Z, I was buried in the back. I had to have a full page ad to be seen in front of AAA Dental, and AAAAA Dental. Everybody put more A’s in front of their name to get to be first. We used to have $10 000 a year Yellow Pages ad plus God knows how much we put into every gimmick like being on the supermarket carts and advertising on the bowling alley score sheets which are now digital, so they don’t have those anymore, cash register receipts at the supermarkets, I mean limited by only how much money you wanted to bury in an advertising campaign to determine your budget. You can do all this stuff digitally with better demographic targeting for a fraction of the cost that we used to do print advertising for.

Howard Farran: Okay Ed, and more specifics. You mentioned Likeable. Do you have a www for that, do you have contact information for our viewers?

Ed Zuckerberg: Likeable Dentists.com

Howard Farran: Likeable Dentists.com, and you said $2000 a year?

Ed Zuckerberg: You can just ask Henry Schein that.

Howard Farran: And you said $2000 a year, now does that $2000 a year go to Likeable Dentists or does that include purchasing this $5 a day budget or $10 a day budget?

Ed Zuckerberg: They don’t include much advertising, I’m not exactly sure what they include. I’m guessing they probably include maybe one ad a month or something like that where they probably budget about 25 bucks a month, something like that. Real minimal. I think the average dentist probably should be spending a few hundred dollars a month. Not a lot.

Howard Farran: Who is Likeable Dentists? What’s the name of that guy?

Ed Zuckerberg: Dave Karpin with Carey Karpin founded a company called Likeable Media probably about seven or eight years ago, probably around the time the Facebook pages for business was born. They subsequently split their company into Likeable Media and Likeable Local, so Likeable Local deals with a bunch of different verticals. So they have like Likeable Dentists and Likeable Lawyers and Likeable Florists and Likeable Jewelers and each one realizing that while a dentist might not be a big marketing target, the group of dentists as a whole represents a sizable audience which, there’s an economy of scale to market to. So you know, if you’re a client of Likeable Dentists you might have the same kind of content, or the identical posts that some other dentist is another city are using it for their content.

Howard Farran: Ed, how crazy is this statement: what’s more important, a dentist’s website or his Facebook page, because in my 52 years of life, I’m seeing like my four boys, the hours they watch on TV are almost completely gone. I mean if it’s not an NFL football game or a UFC fight, they’re just always staring at their blogs and Facebook and a lot of people think well why do they spend so much time on Facebook, like you say, well it might be one of their friends with a link to a study, like a lot of times I’m on Facebook and it will be a link to Harvard Business Review or they’re engagements there but do you see Facebook making a dentist’s website less important since more and more people are on Facebook or are they complimentary?

Ed Zuckerberg: Definitely complimentary. They should both feed to each other but there’s two real main differences. So for example, having a really top website is important in attracting new patients because when patients do a Google search looking for a dentist or they’ve just gotten a word of mouth referral from someone, or they maybe they saw your own Facebook ad and they want to know more about you, and your ad may actually drive them to your website because this is probably the best place to maybe see like staff bios and stuff like that.

So it’s important that your website makes a great impression of your office to get that initial new patient to select your office and go through the process. Also it’s a great place to host necessary forms, new patient forms to download and stuff like that. In terms of ongoing engagement, once a patient is already a patient of your practice, the importance of the website is really minimized.

So let’s draw on something we discussed earlier and discuss the new piece of technology just put in your office, like you just put a new CAD/CAM machine in your office and what a lot of the companies will do, and by the way I took a surgical course 10 days ago in LA on the Chao Pinhole Surgical Technique.

Howard Farran: Sinus lifts?

Ed Zuckerberg: Yeah suture less, incision less, graft less ways to deal with root coverage that was very impressive and I enjoyed very much and one of the features of the course is they actually help you set up what they call a tower website for the attendees. A website to drive patients to learn about the technique.

But say someone is already a patient of your practice, so one of the things you’ll do with this technology is you may call your web designer and say hey, I’ve got this E4D now or this CAD/CAM, CEREC or whatever you’ve got and I want to tell all my patients about it so they pay for a really nice page that tells everybody all about the CAD/CAM and the technology and what they can do and nobody sees the damn thing because your existing patients are not, they’re busy surfing the net, they’re busy on Facebook. They’re not saying oh it’s 10 o’ clock, I’ve got nothing to do. Let me check out what Dr. Zuckerberg has on his website that’s new from the last time I checked last week- not. That’s not happening.

They’re not going to your website so that’s not going to get the message out for the CAD/CAM. On the other hand if I put up a really nice Facebook post telling my fans of my page about this new technology I have, and then I spend $30 or $20 to boost it so that not only every one of my fans sees it, but maybe even friends of the fans see it. Now, they’re passively getting the message in their Facebook news feed. I don’t have to rely on them going to my website to visit my website to find out about this new technology which is probably hidden in some obscure page on my website. I’m now letting them know that the technology is there in my office and if you think about it, how many patients in a practice are really going to get exposed to this CAD/CAM technology? Maybe 10% of your patients will ever need a crown or an inlay or a veneer that you’re going to fabricate it with and you want all your patients to know that you have this technology available, so maybe they’re with a friend who complains to them that they’ve got to get to the dentist, their temporary crown fell out and they can’t have cold or something like that and oh! My dentist has this, he does his crowns in the office the same day, in one visit.

You should be going to my dentist, and even if the patient doesn’t need a crown they read about the technology you offer on Facebook because it’s being sent into their news feed passively and it reinforces to them, wow I’m really glad that I chose Dr. Zuckerberg as my dentist, he is really with it. He’s got all the latest stuff and I know he’s taking really good care of my dental health.

Howard Farran: So that makes a lot of sense. So you’re saying basically a website could pretty much only be for external marketing, for new people to find you a Google search or look up your name and number but it really doesn’t do any internal marketing. I’m thinking about my doctors, my physicians, my dermatologist, I’ve never gone to their website but if I like their page, I’d be seeing new stuff from my dermatologist.

Ed Zuckerberg: They’ve got to drive traffic so what a lot of dentists do, and there’s one dentist that I’ve consulted with in the Washington DC area who has an amazing blog that he sends via email to his patients once a week. He really takes a lot of time and puts real thoughtful content into the blog, focusing on a particular topic. You know he’s got a geriatric practice, and anyone who really likes the blog they look forward to seeing his blog on a weekly basis and the blog is going to have links to his website for them to find out more. So he’s using the blog to drive traffic to the website where there might be other interesting content.

Unless you’re really driving that traffic, people aren’t going to your website.

Howard Farran: I ran out of time with you, I only get an hour and it’s an hour and four minutes, can I squeeze in just one last question?

Ed Zuckerberg: Go for it.

Howard Farran: What about this check in facility you see? You see people on Facebook that say I just checked in at Starbucks or I just checked in? Should a dental office- what are your thoughts on checking in, should a dental office?

Ed Zuckerberg: The most underutilized thing in business is checking in.

Howard Farran: Explain.

Ed Zuckerberg: The most valuable way for a business to promote itself on Facebook. 

Howard Farran: First explain what it is to the viewers who don’t understand what check in is?

Ed Zuckerberg: So everybody’s smart phone has a GPS on it that knows their location, unless you’ve disable it and what that means is if you have an app like Facebook or Foursquare or Yelp or any number of social applications on your smartphone, when you open the app, the app knows where you are. When I open OpenTable to make a restaurant reservation it knows where I am and tells me the restaurants in the area that I might want to dine at. So when I’m at a place that I want to share with my network of friends, maybe it’s an amazing restaurant I’m eating at where they have a phenomenal dish that’s knocked my socks off, so I’ll open my Facebook app and I’ll, there’s a check in tab and I’ll click check in and up will pop on my phone a list of maybe 15 businesses that are within a couple of hundred yards of where I am physically located at that point in time and the business that I am currently visiting should be in there, so I click on that business and then I might use my camera to take a picture of this dish that I’m eating and then I might say something about it and then I would have just created a Facebook status post that I just had this amazing chicken dish at this great Italian restaurant in San Francisco.

Now my friends see a few things. First of all I’ve promoted the business for the business. So why am I doing it? It’s kind of a thank you to the business for being great but in some cases maybe the business is going to incentivize me to check in. Make it even more worth my while. We had an incident in the office a few years ago where we used to get these one or two boxes a month of these patient size samples of Aquafresh toothpaste and somebody hit an extra zero at their computer, all I know is the UPS guy delivered 100 boxes of 24 packs of Aquafresh toothpaste and my assistant goes well what are we going to do with all these? Can we store them in the basement? I said well if you do that, they’re just going to get buried.

I said first thing, let’s call like Churches and Synagogues, a lot of them are doing midnight runs and they’ll stick them in their giveaway packs and then I said wait a minute- this reeks of a check in promotion. Check in, forget about the one toothpaste sample that we’re sticking in the patient bag now with their toothbrush when they get their teeth cleaned by the hygienist, let’s give out a whole case. 24 of these, and all you’ve got to do to get your case is check in while you’re here.

So they check in and here’s your free case of toothpaste, and they’re thrilled and guess what? Every one of their average of 300 friends in their network just found out that they just checked in at Dr. Zuckerberg’s dental practice.

So that carries with it an implied referral. An implied word of mouth recommendation. Hey John uses Dr. Zuckerberg as his dentist. I could use a new dentist. And the funny thing is that we had a patient who was coming in for a tooth extraction and they didn’t want to drive home so they had a friend drove them and the friend goes can I get a case of toothpaste too, and the receptionist said why not, just check in. So we had someone who wasn’t even a patient of the practice checking in, got their free case of toothpaste and all their friends found out they were in Dr. Zuckerberg’s office too.

Now their friends don’t know that they’re not a patient of mine and that they were just driving someone who was getting an extraction done. So I might get referrals from someone who’s not even a patient of the practice because he checked into my office to get a free case of toothpaste.

Howard Farran: I knew when I said that, I’ve never had dinner with you or met you or talked to you or heard you speak where I didn’t learn something. I knew you were going to teach me something profound today and you delivered it right on. That’s just amazing. We’re out of time but I was wondering, for everybody who didn’t watch this podcast, our Dentaltown magazine goes to 125 000 dentists each month, any chance I could get another amazing article out of you someday?

Ed Zuckerberg: Oh absolutely.

Howard Farran: I would love that.

Ed Zuckerberg: I’m always writing stuff.

Howard Farran: Well send them my way. It was an honor to have you today, thank you for being my guest and thank you for all that you do for dentistry.

Ed Zuckerberg: Pleasure Howard, same for you.

Howard Farran: And if any of our viewers want to ask you a question, is there any way?

Ed Zuckerberg: Anybody who is interested in having a Facebook page or has a Facebook page and really wants to know how to kill it and take it to the next level, they can get free tips at my Painless Social Media Facebook page. So on Facebook, just go to Facebook.com/Painless Social Media and even though I’m not an active, every day practice any more, my Painless DRZ Facebook page also has lots of great content that we still put out on a daily basis that they can feel free to share on their own page as a source of content like they can with your content.

Howard Farran: And that brings up a question a lot of you ask on Facebook, like if a dentist went to your Facebook page and saw a photo, a lot of times they wonder can they legally just put that on their page or is that a copyright infringement?

Ed Zuckerberg: Totally. They can absolutely share anything they see on anyone else’s Facebook pages, because you have to understand with a business page, all the content is public. Anything on your business page, my business page that we post is public. It’s out there for everyone and we want as many people as possible to view that content so we welcome other dentists and even other non dentists to share our content. Not only will our content be seen by more people but Facebook will always give the source credit. So if I share something from your page Howard on my own office page or my own personal page, it’s always going to say that I shared the content from Howard Farran’s Facebook page.

So the original source is always going to get credit for it too.

Howard Farran: I notice when I said can they contact you, you gave a Facebook page. You didn’t give a www, so you, Ed Zuckerberg aren’t really using a website? You’re just using Facebook as your website?

Ed Zuckerberg: Well if they go to Painless DRZ.com, which was my old website for my office in New York, they will be taken to the office in New York where another dentist has now taken over my practice. Soon we’re going to update that and soon visitors to Painless DRZ.com will have a choice of visiting Dr. Zuckerberg’s old practice in New York, because we don’t want the patients who have been going to that practice and are used to going to that website not to have access to it, but they’ll also have a choice to visit the office where I work very part time now in California.

Howard Farran: Alright well again thank you so much for your time and your last article on Dentaltown was a huge smash. If I could ever get another one from you I’d be eternally grateful. Thank you Ed again!

Ed Zuckerberg: Take care Howard.

Howard Farran: Okay bye-bye.

Ed Zuckerberg: Bye-bye. 

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