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"If I'm a dental hygienist, it's my job to help my patients want to come and see me."
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AUDIO - Debra Seidel Bittki - HSP #125
Watch Video here:
VIDEO - Debra Seidel Bittke - HSP #125
Keep drilling, filling, and billing. Let Debra Seidel Bittke worry about the other stuff.
LINKS TO TOOLS DISCUSSED ON THE
Programs Dr. Howard
Farran participated in with Dental Practice Solutions:
45 Day Dental Hygiene
7 Day Dental Hygiene
Time Management Resource Also Mentioned During Podcast:
ABOUT DENTAL PRACTICE
Debbie Seidel-Bittke, RDH, BS, began her career as a dental
assistant and office manager and also graduated from the University of Southern
California with a bachelor’s degree in dental hygiene.
She is also a former clinical assistant from the University
of Southern California and co-taught the senior dental students Practice
Management course until the school went to a PBL learning format.
In 2000, she founded Dental Practice Solutions and works
with dental practices world-wide to:
create profitable and sustainable dental hygiene
known for reactivating and retaining patients
for dental practices world-wide
organically grow new patient numbers
Debbie believes that
the key to a successful dental practice is:
share the message that “Optimal oral health will
lead to a longer and healthier life.”
this message is embraced by the team, practice profitability will grow
refer their friends and family, etc.
say “YES” to treatment
Dental Practice Solutions creates:
sustainable dental hygiene departments
throughout the world
creates a “team-driven” practice, where the
employees feel like leaders vs. employees
means doctor can come to the office to do their job as Dentist not manage people
In 2007, Debbie wrote the accreditation for a dental hygiene
program in Portland, Oregon and spear-headed the build-out of the college,
wrote the curriculum, hired the team of professor’s and purchased all
equipment, etc., etc.
For the last ten years she has been named “One of
Dentistry’s Top Leaders in Consulting” by Dentistry Today
Debbie has spoken in most states throughout the United
States as well as Canada and abroad.
Office: 503-970-1122 or Toll-free in the US: 888-816-1511
Howard: Today is going to be a huge honor to interview a very good ... You're a role model and an idol to me in so many ways because dentists always want to talk about drilling, filling, and billing, and you are really the queen because you are talking about prevention. Everything we're doing ... I mean, I've got three uncles, and between the three of them, they don't have one tooth.
Dentistry has really changed over the years, and you are the king or queen of getting people to reduce, prevent disease. Too much of healthcare, especially the American healthcare system, it's all about surgeries and cutting stuff and stents. When you think of a heart disease in America, you start to think about bypasses and stents, and that's all everyone is talking about instead of just, "Hey, why don't you just quit smoking, lose weight, and exercise everybody."
Your program I did with you, what was that, the 21 Day ... the email, where you were emailing me everyday?
Debbie: Oh, I don't know. Did you do the 7 Day Dental Hygiene Profits Program?
Debbie: That was seven days.
Howard: Yeah. Congratulations on all your success. You're amazing. The dentists are listening, about 5,000 dentists are going to be listening, I really don't have any stats on what percent oral hygienists is, I really don't, I know it's about 5,000 dentists. Dentists want to talk about drill, fill, and bill. Dentists want to talk about placing implant, doing root canal, removing decay, bonding, all these kinds of stuff. I don't think they focus enough on the perio department. Do you agree with that?
Debbie: Absolutely because, do you know how I know that, Howard?
Howard: How's that?
Debbie: Well, they allow us to look at their production and their collections in their hygiene department. This year, what we see is, across the board, doctors doing 90% of the work and the hygienist 10%, of all the practice. We have doctors that want to do ... They're hoping to break $2 million this year and they're doing 90% of all that work.
Howard: What do you think the hygiene department should be as a percent of revenue?
Debbie: I'd like to see it closer to 30% of the total revenue.
Howard: What is a dentist that has a hygiene department doing 30% of revenue doing differently than a dentist who has a hygiene department doing 10% of revenue?
Debbie: Well, I just have been doing a lot of writing from the perio AAP, the Academy of Periodontology, and they say that I think it's only ... Well, they say 64% of Americans have periodontal disease and very few, maybe 30% of those people are being treated for periodontal disease. Honestly, I think it's a lot higher than that.
When we look at our dental practices when we're first analyzing them, we find that the highest we've ever analyzed has been 22% of the adult patients are being treated for periodontal diseases. If the AAP says, "it's about 60% of the adult population at least have periodontal disease," and you're only treating 20% of your adult population. What's missing here?
Some people don't understand, bleeding gums are not a sign of health. There are so many hygienists that are doing bloody prophy. I've been doing a lot of writing on that this year to make a huge dent in what's going on.
Howard: What is your perio program? First of all, your dentalpracticesolutions.com, first, start off with tell our listeners what it is that you do.
Debbie: I have a holistic approach. My niche is the dental hygiene department, but we can work on profitability in the dental hygiene department but the collections, what we see a lot of times in many offices recently, 70% collections. It needs to be more like 98% and I don't care that you've got all these PPOs, it's how you can elegantly communicate to your patients, "you matter to me." That's going to change those numbers.
We take a holistic approach to make sure that the bottom line increase in profits without working harder. A lot of that has to do with that dental hygiene department that's only functioning at 10% of the total production. Doctors don't even realize it because they never look.
Howard: What do you think these 5,000 dentists listening, what do you think they are missing on their perio department, their hygiene department? When you walk in offices, and you've been on gazillion offices, what do you usually see and what do you usually do to change that?
Debbie: The doctors are usually just drilling and filling and they only know what they know. For example, I just got off the phone with an office, doctor has got two practices in New Mexico and he can't keep his eye on both of them. He loves the office manager, he was telling me. He's busy drilling and filling. He's seeing 15 patients today. He's got his eye on the tooth and not on the numbers.
I come in there and the first thing we do is look at the bottom line numbers. What are their new patient numbers? What is the production versus the collection? What are those PPOs that you're signed up for and how is that working for you? How many patients need to be reactivated? I'm telling you Howard, it's probably nothing new to you, but you know there's over 100 patients that have been boxed their dentists. Most offices have over 100 patients that need to come in.
What kind of treatment plans are outstanding? Hundreds of thousands of dollars in treatment plan, and the patients, they never accepted them. We'd have offices when we first started working with them, the first week they had nine hygiene patients cancelled. They have two hygienists working four days a week and nine of those patients cancelled. Then they did some treatment planning. They sent me their key metrics that end of that week and I was there observing for four hours. At the end of the week, I found out that $28,000 in treatment plans walked out the door.
Unless doctor would have talked to me, he would have never known it and it would have never been a plan. We're now working with that client and the first thing we did was work on this gap, huge gap, wouldn't you say, with the team. That was one of the first things that we did, was discover how to stop those patients from walking out the door. It's much easier to stop the cancellations than those patients walking out the door not accepting treatment.
Howard: I want to start with the most controversial question relating to dental offices and hygienists. When a patient calls and wants appointment, they were only calling because they want their teeth cleaned. Do you do first appointment cleanings or not?
Debbie: When somebody is a new patient, are you asking about a new patient?
Howard: When a patient calls a dental office, usually they want whiter, brighter, sexier teeth, and one of the biggest reasons someone calls a dental office is they want to come in and get their teeth cleaned. Some offices say, "No. You can't do that. You've got to come in, first appointment is for X-rays and exam and a consultation, and we don't do first appointment cleanings." Then other dentists are sort of saying, "Well, I want to be consumer-friendly. This is what they want. I'm going to give them a new patient's cleaning." What do you say about that?
Debbie: I think that the patient needs to come in to have a doctor exam and some X-rays. I mean, I'm very flexible, we can work with many ... It goes both ways. Some doctors want to see the patient first. We create a plan for that and they can maneuver into the hygiene department. Other offices, they insist that they see the hygiene first and I believe, I personally believe, they should see the doctor first and establish a rapport with the doctor, and then they can move into the hygiene department from there.
Howard: It's also the law of the land that nobody can take X-rays and do a cleaning until they have a diagnosis, and the doctor has to do the diagnosis. Legally, the doctor has to see the patient first to say you need to take X-rays, or you can't clean or do whatever. I agree that that's probably the most violated law in dentistry.
Debbie: What about California and Oregon, where the hygienists can have their own practice?
Howard: Is that a new deal? I wasn't aware of that? I knew it's a law in Colorado.
Howard: California and Washington ... Oregon have allowed independent practicing?
Howard: When did that happen?
Debbie: Within the last 10 years since I've been here in Oregon, hygienists actually have their own practice. They are doing facials, some of them, aestheticians, and dental hygienists doing scaling and root planning, aesthetics, et cetera.
Howard: Do you know any of them?
Debbie: I do.
Howard: Oh my God, email me their names. That would be an amazing article or podcast or whatever on dentistry.
Howard: I just talk to you, I thought that was only legal in great state of Colorado, which doesn't matter anyway because all the patients are stoned they probably don't even know there's a dentist in the room or not, right?
Debbie: You know what, Howard, unfortunately, I think in a week or two, they're going to be stoned in Oregon, too. You know about that law that passed.
Howard: No, I didn't.
Debbie: Yeah. You can actually have your own business selling cannabis.
Howard: It's no longer medical marijuana, it's just totally legal?
Debbie: In Oregon and Washington.
Howard: I do want to say, there are international viewers, there's a lot of things about United States embarrass the hell out of me. The fact that we have 5% of the world's population and a quarter of the world's prisoners is embarrassing. I mean, we have more prisoners than Russia, China, Iran, and Saudi Arabia combined. I mean, how does that even happen? I mean, crazy.
Debbie: You know what, Howard, it's the government and they're getting paid. Lots of taxes on it. [Inaudible 00:10:32]
Howard: I see the American flag behind you. What made you put up the American flag as the background?
Debbie: Howard, I'm just going to be honest with you. I'm a hard working woman, I'm a multitasker. I don't want you to see a messy office. In honor of Independence Day, we thought we'd put the flag up.
Howard: Right on. We are taping July 1st. This is Wednesday, July 1st, and Saturday is the Fourth of July. What do you say ... Okay, this is the common problem that we see dentists [inaudible 00:11:08] for all time. You've got two hygienists in the office and if one hygienist sees the other hygienist patients, a lot of them are saying, well, she probably had perio three millimeters or less. I've got fours and fives and sixes. What do you when you have two hygienists and they're not consistent on probing, diagnosing, and treatment plan and one is more inclined to treat perio and the other one is more inclined to treat bloody prophys?
Debbie: Yes. It happens all the time when there are two or more hygienists, we've got this situation going on, so we've got to calibrate. We actually have online training videos and then we go in quarterly. Usually, the doctor hires us to go in quarterly besides our online programs, and then we can calibrate with them. We actually work with type-it-ons and then work with each other. There are volunteers from the team and we work on each other and roleplay a lot of things. It's also the doctor, Howard, it's also the doctor that needs to agree with the probings with the hygienist as well.
Howard: Right. When you meet ... By the way, a very way to follow up this information and would be a good marking for you, is you have those videos. Your website is amazing. You should construct a one-hour online CE course for Dental Town, because we put up 317 courses and they just passed 518,000 reviews. If you put that one hour course up there ...
I think a lot of consultants think, well, if I show them my stuff, they're not going to call me. I think it's the exact opposite. I think if you show them your stuff, then it's kind of like, when I go to a restaurant, I want to order salmon or steak or tuna and they need to see that your salmon or steak or tuna, and once they see it, they're not buying the information, they're buying the implementation. The reason they write a check is to say, I'm just not going to get it done.
If you put up that deal and tell them what you do. For every one person that says, "Oh, now I get it. I'll implement it myself," another person is going to say, "Man, I wish my hygiene department would do that. I'm going to hire you to get it into shape."
What do you do when you walk into an office and you've got some hygienists, such as old as I am, 52 years old, and she's been banging out bloody prophys for 28 years? Do you take her to a vet and just put her down, or do you try to change her ...? How do you deal with that? I mean, you don't teach an old dog new tricks and she's been doing bloody prophys for as long as I've been a dentist. What would you do with a person like that?
Debbie: Okay. We actually go through a training program. I have another consultant. I have two other consultants that work with me. I call Donna, the Good Witch of the West, she's Glinda. Yeah. We actually take them through some training. Usually, the first one is through a webinar. We have to go really slowly. What you are talking about is fact, it happens all the time, so it's nothing new. We actually have to go very slowly and we have to consistently ... I mean, it takes probably two webinars, two hours with these hygienists that you're talking about, where we have to consistently almost brainwash them to understand we are in the business of creating longer, healthier lives.
I mean, it's almost like, have you heard of EFT? It's like the tapping, we are in the business of creating, longer, healthier lives. They can hear you say it, but an hour isn't going to get it, it's constant repetition to get that embedded in the brain. These people that you are talking about, these hygienists, still think they're cleaning teeth. They are there to clean teeth. It's just having them understand and embrace that we are no longer a cleaning lady. We are preventive care therapists.
Howard, did you know that the reason why I'm so passionate about this is because my mother died in 2002? She had a tooth infection and then got endocarditis within a couple of months after that. She died from endocarditis.
Howard: Do you think it was from the tooth, odontogenic origin?
Debbie: I don't know. She had a tooth infection perio/endo abscess that I found. Then she had the tooth extracted and two months later she was dead.
Howard: I'm sorry to hear that.
Debbie: I'm very passionate about this message. I had a very prominent hygienist, I don't why, but she responded that she wanted to see the research. She said show me the research that oral health, that our message as hygienists should be oral health creates a longer healthier life. She actually is prominent, I'm going to say her name right now because everybody knows who she is, and she said show us the research.
Howard: Can we alternate prophys with perio maintenance?
Debbie: Absolutely not.
Howard: Explain what I just asked and explain why not.
Debbie: Can we mix up ... Somebody goes through scaling and root planning and then they enroll in perio maintenance. Let me give you an analogy. Somebody has diabetes. We're going to be testing for their blood glucose levels, correct?
Debbie: Easy plan. Does the doctor ever decide not to check for diabetes?
Debbie: Same thing with periodontal disease. If those inflammatory markers are the same, so imagine that you have inflammation in your blood that causes diabetes, cholesterol, high blood pressure, arteriosclerosis, rheumatoid arthritis on and on, those same inflammatory markers are causing periodontal disease.
When you look at the definition of periodontal maintenance, one of the last sentences in your CDT code books says, "for the life of the dentition." There's your answer.
Howard: I want to ask you this, I hope this doesn't embarrass you, but it's a reality, if the physician saw Mary every three months for 10 years and every time she came in she had chlamydia and you had to give her another round of Amoxicillin or something, a physician would stop and say, "Can I see the person you're sleeping with? I think since you have chlamydia every three months for the last 10 years and you sleep with one person, I want to see that person."
What do you think when you go into a dental office and they've seen Mary, every three months for periodontal disease for a decade and they've never seen her husband, and I'm just standing there, I'm saying, "Hey, Mary, do you sleep alone or do you sleep with someone?" She goes, "I've been married for 20 years." "Do you kiss your husband everyday?" "Absolutely." "Do you sleep with him everyday?" "Absolutely."
Do you think you can treat periodontal disease in a mouth every three months when she's going home and sleeping and kissing and trading saliva with someone in bed who doesn't see the dentist?
Howard: Do you think they're just giving bugs back and forth, or do you think that's not an issue?
Debbie: I believe that they're giving bugs back and forth. I think that some people have an immune system that can potentially put a halt to that, but not everybody has an immune system that can put a halt to that. You know what I mean? It's like somebody could have HIV and never get AIDS. There are some people that it could happen. I've been married 18 years, I'm sure before those 18 years of marriage, Howard, I kissed some guys, in fact, I know they had perio disease and I don't have perio disease.
Howard: I was lucky. I'm from Kansas, I only kissed goats and sheep and didn't have periodontal disease.
Debbie: Whoa! That's the first time I found out about that. Because my dogs got perio disease and I'm glad you don't kiss dogs.
Howard: That was just a joke, but yeah. I tell you what, building your practice, I mean, I don't say it from a business reasons, I say it from my heart, every time I have ever told that to a patient in my office or any of my friends office [inaudible 00:19:50] the lady said, "Oh my God, are you kidding me?" I call her cellphone or her husband. "I'm checking out and I'm going to go over to frontdesk and you're coming in here, because I have, with everything I am going through I'm not going to be trading bugs back with you."
I think you're right. I believe that most things that are yes-no, left-right, up-down have all been figured out and everything that will be figured out in the future has many, many more variables and part of the equation is bugs. I mean, you're not born with [inaudible 00:20:22], you're not born with Streptococcus mutans, you're not born with any of these bugs, you're not born with HPV, you're not born with ... I mean, half of these bacteria and things that we find, you weren't born with, so it had to come from somewhere.
Then I'm going to ask you the other million dollar, in fact, this is probably a 10 billion dollar question. Because last year in the United States, 20,000 general dentists and 30,000 specialists build out a 103 billion bucks, and for the planet, there's two million dentists and they build up almost half a trillion, 500 billion bucks. This is probably a $10 billion dollar question.
Howard: "Debbie, I don't think it's working to see you every six months, I need to start seeing you every three months." Debbie says, "Wait. I've got Blue Cross and Blue Shield and they only pay to see me every six month, so I can't do that." Every dentist listening to you right now, 5,000 dentists will say, "Oh yeah, I heard that last week." "I heard it this week, it's Wednesday." "I've already heard it this week." What do you say to those patients.
Debbie: I say something different to each patient, but I'll tell you something, Howard, you just talked about that patient that you were bold enough to talk about who were they kissing, well, probably that patient that was kissing all those people with perio disease, they probably are the same person that came into your office with that new iPhone 6 Plus and they've got a whole sleeve of tattoo up their arms. It's like, "Hey, did your insurance pay for that?" They'd be like, "No."
I would talk to my patients when I was a hygienists and I teach other hygienists. In fact, I was just talking about this recently to a group of dental professionals because they can afford these things. People buy what they want and not what they need. I believe it's our job as dental professionals to get our patients to want what we have as dental professionals.
It's our job. If I'm a dental hygienist, it's my job to have my patients want to come to see. That's why I became a dental hygienists. I mean, was a dental hygienist. So many doctors that I had worked with knew that I was passionate about getting my patients to want to come in to see me.
When I went on two-week honeymoon with my husband nearly 18 years ago, those patients came in and, unfortunately, a lot of them walked out the door because they didn't want to see anybody else but me, because they know that what I say is the truth and they've come in looking forward to seeing me with a relationship.
I believe that your patients believe in you, they trust you, and what you say, hopefully, is God's word. Don't you agree? Don't they think you're like God's word?
Howard: I think the most backward thing in America, and you can even say, what the hell would that be? The most backward thing is, you say to any American, what car do you drive? They tell you. How much did it cost? They say, it was exactly this amount. You say, "Well, you just had an artificial knee replaced. How much is that?" "No idea."
You know your car costs 22,000? What do you think your knee costs, 10,000, 20,000, 30,000? "I have no idea." "Who paid for your knee?" Oh, your employer or your government. "Who paid for your car?" "I did." You go scratch their car in the parking lot and they go ape shit, but when it comes to their own body, they've got a cigar on their hand, they're drinking Dr Pepper, and all they want to know is what is their boss or Obama going to pay for their human body. That should just be reversed.
I've read that Obama and the government and your boss took you to and from everyday. Then you own your own body, you took care of it. I mean, because people take care of their house and their car and the things they buy themselves far better than their own human body and they just want someone else to take care of it.
Debbie: You said it, it's like they need to take responsibility. How can we communicate to our patients so that they want to take responsibility so that they want.
Howard: I think social animals, dogs, cats, humans, are enablers because they are social pack animals. They say to me, "Well, the insurance won't pay for a bridge, they won't pay for an implant." I say, "Well, what if your doctor or your government only pay for your castration and not of the sex mate. Do you want me to cut your balls off or [inaudible 00:25:01]?"
I don't give a shit what your insurance company says the implant is made of titanium and can't get a cavity and the reason you lost a tooth is because you don't brush, floss, you have massive cavities and you want me to file down two adjacent teeth. You know what, in six years, then we're going to lose all that, we're going to still be back to square one. We're still going to be back here except instead of one tooth now it's going to be three. I think we're enabling them.
It's kind of like the husband who's always complaining about his wife is an alcoholic, drunk and then she'll say to him, "Honey, I'm out of beer and I can't drive because I drink too much, and I can't get my blow device to work. Will you run to the liquor store to get me a case of beer?" "Oh, sure, honey, I will. I will." Everybody enables everyone.
Then what's also interesting about being an international speakers, there's no dental insurance in Asia and Africa and South America and these guys are doing just fine. Then in America, it's just this mental crutch.
Same thing with speakers. They're so caught up in their presentation and their slides and their video and their three-piece suit, they're just stammering around. The best lectures I ever gave is when the airplane lost my luggage, lost my PowerPoint, lost my slides, lost everything and I showed up in a pair of blue jeans and a Harley-Davidson t shirt, took the microphone and just ranted for eight hours without all those crutches.
I think insurance is just a big crutch. I think it's an atrocity that an American can get an artificial knee or a hip or a bypass and not have any co-payment and not even know how much it costs.
Debbie: Howard, they know that they have benefits with their employer. What I ask them is, "So you get this specific benefit, they cover maybe a thousand dollars of your dental care, and they give you a vacation, right?" They're like, "Yeah. I get two week of vacation." "Do they pay for the cruise? Do they pay for the air fare?" They're like, no, no. I'm like, "It's the same thing with your dentistry. They're not going to pay for X, whatever it is."
Howard: I've never heard that analogy and that is a rocking hard analogy. You boss is giving you a two-week vacation but he's not paying for the cruise. He's not buying the airline ticket, he's not buying the Disneyland ticket, they're giving you 1,000 bucks. You should be thankful. But you're an entitled spoiled brat, lazy American and you wanted to include everything on the vacation. That's just not how it works.
Then I remind them that me and my assistant, Jen, I saw my first dental assistant, Jen, for 20 years, I remind them ... By the way, me and Jen, we didn't have a cavity in 20 years. We brush and floss every morning, brush and floss every night; and all this stuff you're getting, me and Jen don't get. I don't even know why you bring your employer or Obama into this equation?
Debbie: Howard, you brought up a really good point about international because I feel so blessed that I get to work with clients as well in other continents. In Cyprus, they're right next to Greece, they're rocking it. It's all because they know how to elegantly communicate. My doctor in Cyprus loves to do implants; he does hundreds. They'll do at least 200 implants this year. Do you know how many new patients they've seen as of June? I talked to him on Monday, June 27th, they had 270 new patients in this small island of Cyprus.
They're rocking it because they show their patients that "you matter to us, we care about you." They have a relationship with them and they understand. They're paying for their implants, Howard. Their economy has been hit hard, right? In Central Greece?
Howard: Well, I still think that if I was to go to Debbie and I was do takeaway half of Ricolas in her closet and her car or bicycle or whatever, she might matter to the world or whatever, but I went into Debbie and I took out number eight ...
Debbie: Oh, that's a nightmare.
Howard: Yeah. Your whole world would stop. You would no longer care about the house, the car, the vacation. Dentistry is the easiest sell in the world because people will tell you, "I felt this lump here for five years." They'll feel lumps and have diarrhea and not feel right or whatever for years and years and years, but you take our her front tooth, and it just stops.
Dentistry is the junction between physical health and extreme cosmetics. Women just aren't going to go outside when they lose all their teeth and they lose all their hair, 100% of women stop and say, "I will wear wig and I will get my teeth back even if I have to sell my car." To get caught up with their enabling thing, it's not even necessary, because they'll prove to you over and over and over and over that cosmetics and their teeth, they mean everything to them.
Debbie: Absolutely. One of the things that I like to ask, and I talk to my clients and the hygienists about this, have you ever asked your patient, how long you want to live?
Debbie: Have you ever asked that to a patient?
Howard: Uh-uh (negative).
Debbie: I used to ask this all the time of my patients. When I was hygienist in California, I would ask them, "How long do you want to live?" I've never had somebody say, "Oh, I don't want to live much longer." When they tell me that they want to live another 10 or 50 years, I'm like, "Well, here's what you have to do. Let me tell you a little secret."
I actually had a physician who was so head strong. They told me before he came back to see me, they said, "I just want to let you know, don't ever talk to him about flossing his teeth because he walked out on the last hygienist that tried to tell him to floss his teeth. I asked him if I could tell a little secret and I got in like this, it's just getting down at their level, and he's like, "Well, of course, I want to know the secret." We started talking about perio and what he needed to do to prevent it.
Just get down to their level. Some of those patients that you're talking about aren't going to put up with you talking to them about who they kissed and about who they slept with, but there are some patient you can talk to about that. They probably come into your office expecting that.
Howard: Yeah. Well, you can't ask them who they're kissing because their brother might be in the next operatory and that's the one. By the way, I want to ask you another thing about this. A lot of dentists when they look at you they think, hygienist wants our prophy, some people say 50 minutes, some say scheduling [inaudible 00:31:57]. How much time do you think a hygienist should have on average for a hygiene department?
Debbie: My discovery, my years as a consultant observing offices, if they have an hour for an appointment they're more likely to produce more money, so 40 minute. I have some offices that will have 40-minute appointments no matter what it is. I'm telling you, those are the offices that are collecting 70%, and those are the offices that have patients walking out saying no to their treatment plan.
If the hygienists are passionate, enthusiastic about what they do in their careers as a hygienists and you give him 60 minutes, they should be able to produce close to, if not, $2,000 a day production.
Howard: Let me ask you my two other economic questions about hygienists. Do you recommend that they be paid hourly or production?
Debbie: I believe that they should be paid production, but I also like to implement a bonus. Then because of the bonus, the hygienist, most hygienists feel more inspired to do somebody same-day services. They feel if they're getting a bonus because they talked to a patient about a night guard and they took impressions or whitening and they took impression or sealants the more likely to feel inspired to actually complete those service.
Howard: Do you pay them straight production or salary versus production, or is there straight percent?
Debbie: Most offices that I work with, it works well that they get paid per hour and that usually is about 25 to 30% of the ... If they're producing $2,000 ...
Howard: A day?
Debbie: Mm-hmm (affirmative).
Howard: I don't even think the average hygienist is 1,000 a day.
Debbie: Well, they don't when we first start working with them, but they should ...
Howard: After they're working with you, you can get them up to 2,000 a day?
Howard: Okay. Then hourly would be 25 to 30% of that you say?
Debbie: It could be. Thirty percent would include a bonus.
Debbie: I look at all employee salaries, Howard, and I like for them to be about 25% of the total production of the office. From there, we can actually talk about a bonus and we'll actually implement a bonus depended on what other services, like it could be a varnish, it could be whitening. We'll pick some services that we want to promote that are easy services for a hygienist to talk about.
Howard: What do you say the dentist, I've seen these threads then I'll try to go a mile long where the dentist says, "Okay. I have two hygienists and they're making 40 bucks an hour each. I'm thinking about getting rid of one of the $40 hygienists and replacing with $20 assistant and have the hygienist and an assistant go back and forth, the assistant will receive the patient, take the X-ray. Hygienist with an assistant running two rooms as opposed to two hygienists running two rooms. What do you say about?
Debbie: Well, I'm not the type of person that's going to tell you not to do it. I don't see it working well. Most of my clients don't do that. Most of them have higher production by two hygienists having an hour per patient. That has worked very well.
Howard: I agree with that and that's how I do it too, and I agree with that. Why do you think that is?
Debbie: Because I believe that it gives the patient the opportunity to feel like they matter. I just did some videos today on five-star care in the dental hygiene department. I believe in making your patients feel like they matter, like they're very important. I don't like dental patients to feel like they're on a conveyor belt.
Howard: Right. It makes it seem like too much of a clinic atmosphere.
Howard: I just got out of a hospital a couple of weeks ago. This is the third time I've gone to a hospital in my life. All three times where I had kidney stone. It's only thing that can make this old dog cry, it feels like you're stabbed. What's amazing, I got into emergency room at 2 a.m. on a Thursday, 2 a.m. in the morning. the next day Friday at 2 a.m. to that night at 6:30 before I got to see a urologist. I was basically in the E.R. for 40 hours waiting for a urologist and every three hours somebody would walk in there saying, "I'm sorry, what is your name?"
At first you tell him, after 12 hours later, "Dude, I'm in a hospital. I have bands on my hand. How do you not know my freaking name?" Should they just burn this hospital down? I mean, this has got to be the most craziest, insane ... People make fun of the government. It's like, really, you want to make fun of the government? Why don't you go to the hospital? Forty hours, they'd wake me up in the middle of the night and ask me my name. I'm like, I'm sleeping. I have bands on. I've been here for 40 hours. You just woke me up to ask me my name?" I didn't know whether to laugh or cry.
Debbie: Howard, I know what to do. We'll talk after the podcast. I know how to stop you from getting those.
Howard: Hey, the next time I get a kidney stone, I'm not going to go to the doctor. I'm going to get a pilot and fly to Haiti or Brazil or some ... Because it's just crazy.
What do you say to a hygienist when you tell her that you're going to do this perio program, you're going to do all these things, and he says, "I just can't stay on time."
Debbie: Okay. They all say that? I have created what I call a "Down to a Science." I've broken up the hygiene appointment into four different sections and we actually strategize. For example, by the time you're 25 minutes into that appointment, you should have completed oral health history, oral cancer exam, the intraoral camera. We actually strategize what needs to be done at each appointment because [inaudible 00:38:25] that need to be done at every appointment.
By the way, this will take no more than four minutes. It's really like, you don't need to spend five minutes chitchatting with your patients, so we actually have created a strategy. I actually have an ebook on my website that's all about time management. I just got some emails, because it came out, the ebook was out last month, and hygienists are saying that they don't feel as stressed because of that Down to a Science system that I've created.
Howard: How do these listeners, they're going to pull up to their office in 20 minutes. Most of my listeners or 85% are iTunes. They listen to audio or they will not see you there standing behind the flag, only 50% are video on Dental Town or on YouTube, but how does this person get the ebook?
Debbie: They can go to my blogs. I think that was in May. It was time management I talked about.
Howard: Where would they go?
Debbie: Dentalpracticesolutions.com/blog. There's an "s" at the end because there's so many solutions. I have a wealth of information on those blogs.
Howard, one thing I wanted to tell you. You were talking about people, they're worried, consultants are worried about people stealing their information and doctors don't want to hire them because they gave it all away. I thought maybe the reason why you invited me to do this podcast with you is because you saw, for three months in a row now, I've been doing videos. Every week I have a video training. I've been doing about 20-minute training every week and I have more people now following me than ever.
Nobody can steal my information. Doctors try to implement it on their own, it doesn't work. They really do need to have some leadership to guide them through any of this implementation that I'm talking about, so I'm not concerned with people not using my services.
Howard: Do you put these on YouTube also?
Debbie: I do. Yes, it's on YouTube.
Howard: If you're in Dental Town and if you start a thread, when you go to YouTube and you open up, there's share, it's like the YouTube link, but you can also click embed and pick up that code. On Dental Town, you can start a thread and then hit the YouTube icon, dump the embed in there and then that video is on the thread.
Debbie: Okay. Thank you for telling me, I didn't know.
Howard: Yeah. I've always thought the consultants, I've always thought the smart ones understood the entire consulting industry about implementation. It's not about knowledge. The dentist is wondering all the details of your plan, the dentist is saying, "I can't get it implemented." The hardest thing about a social animal, a pack animal, a horse or a cat, is to go in there and get your five other friends in the sandbox to agree with you.
Whenever you bring in someone a hundred miles from you, the dentist could play good guy, bad guy. The dentist could just say, "I know, she's crazy, but that's hat we're going to do." If I'm paying you the check I can throw you under a bus and say, "You know what, look, we're going to give it a try. I know. I know, I know, she doesn't get it. She's in Oregon and we're in Albuquerque, I know, but we're doing this. I'm buying it."
I'll just tell you,"Hey, I've got five people and it's Charlene that's going crazy." The other thing is this, what dentists don't understand is that consultants can't stay in the dental industry. With things like Dental Town and Facebook and Twitter, everyone knows, although bad consultants go away over night because everyone knows and if someone is going to make a living for five, 10, 15, 20, 30 year, they're making money somewhere and all the guys I know that are crashing it, they always say, "Yeah. I brought in this consultant and it was 30,000 and the next year I took home 72,000 more."
I mean, it's a return on investment. If you can't get it done, you can't bury your hand in the sand and it's always a return on investment if you put out the money and invest in your business. They'll say, "No. I'm not going to do that. I'm going to buy and [inaudible 00:42:43]."
Debbie: Some of them are happy with where they are. There are some doctors who don't want to make any exchanges and those are the dentists that by the time they're ready to retire, they actually, unfortunately, give their practice away. You know, Howard, we always measure ...
Howard: They're going to give it away anyway in a divorce, but I'm just saying.
Debbie: Well, last year, our clients, they increased their production no less than 34% with our services just for six months, in six months, go figure, I mean, imagine. They're trying to break $2 million this year.
Howard: This dentist who's driving to work and we're three quarters down, I got you for 15 more minutes, my whole deal with Dental Town is using the internet, which is now into your cellphone, so no dentist ever has Paxil again. All people are kind of delusional about what's really going on with themselves. You're talking to this dentist driving a car, talk about the red flags going on in his office that, because he's probably, "No. I'm always good. I'm good. The economy is tough but I'm in Salina, Kansas and I'm doing good. I don't need a consultant."
Tell this guy right now, driving his car, red flags in his office that really do, everything's fine, but what about this, what about that? Name some of the red flags and what you would do to go in there and fix it.
Debbie: Oh my gosh, we just listed out 10 of them yesterday. One of them is new patient numbers under 30. I don't care if you're in a small town, we worked with clients that are in towns of 2,000 people and they're killing it. The guy is going to break $2 million and it's 30 patients, new patients a month. The hygiene department should be producing at least three times what their salary is. A lot of these doctors that are listening right now, they're not looking at their numbers, so I can say all these things but they never looked at their numbers.
If you noticed that your collections are less than 98%, something is not right. If you know that your hygienist is not treating 30% of your adults with periodontal therapy, something is wrong, because there are 70 million Americans with periodontal disease right now. Then when you get to India and these other countries, it's even higher. Your perio numbers. You've got to look at these numbers. Those are just a few of the numbers right now. You've got to look at the numbers.
Some of the doctors we actually are starting to work with the doctor, actually he's just in the process right now where we're measuring his numbers. It's been difficult because they have Dentrix and they don't know how to pull their numbers, then they don't know what to look at.
We actually worked with the DentaMetrix and it's Rick Willeford, he's the founder of the Academy of Dental CPAs, he's retired now, but created this software. They have Dentrix or Eaglesoft. Rick sends them a link and then we are able to pull in those numbers, so we have an appointment with this doctor who doesn't have the list number.
Howard: What's his name?
Debbie: Rick Willeford. He's one of the founders of the Dental CPA.
Howard: Would you email him and CC me, email@example.com and I'll get him on to talk about this?
Debbie: Yeah. I used his metrics for the first initial analysis, these doctors don't know their numbers and when they do look at their numbers, they don't know what to look at. DentaMetrix gives us the data and then we review it with the doctors. Before I got on to this podcast, we set up with our clients in New Mexico, Monday, we're going to review the data with him. Now we can create a plan to overcome these inefficiencies that are going on.
Howard: I get it. I totally get it because I'm a dentist for 28 years and I could sit in a 40-hour non-stop, no sleep, no break, no bathroom on bone grafting. I really could. I mean, dentist is just ... I mean, we are born to fix teeth. The most fun in my dental office, I mean, the most fun, the reason I could never retire is because I want the emergency patient. I want the walk-in. I want someone in pain, swollen, who can't sleep, who's crying, and I want to get in there and fix it. I didn't go to school for eight years to run a Dentrix report.
How do you deal with that dentist? I mean, I was born to do an extraction and a root canal and how do you make me want to run a Dentrix report? I mean, does that mean that I really should an office manager? Should I call up my spouse at home and say, "Hey, you should come in here and do the numbers?" How do you deal with the dentist who doesn't want to look at the numbers?
Debbie: The way that I deal with that is that I have their numbers and their numbers, most of our clients have Dentrix or Eaglesoft, so we are able to pull those and they come to me. I meet with my doctors several times over the month. One of those meetings, I am going through the numbers that are off.
For example, we had a client in Texas, at a suburb ofDallas. Last year, June, July and August, new patient numbers, the production was just so low. We didn't start work with them until this year. It's looking at those numbers and saying, hey, what was going on? What happened here? It's like, well, my hygienist this, I that.
We also have some data that comes to us every week and there's usually a hygienist, I get the hygienist to be accountable to send me cancellations in their day and what treatment plans they presented and I'm monitoring that. I'll look at that at the end of each week and I'll be calling the office going, "Hey, what happened? We had nine hygiene patients not sure. Doctor, did you know you had $28,000 in treatment plans walked out the door?" That's how I get them to look at the numbers.
You know what, Howard, you were saying it's invaluable to have me looking over those numbers. Even if you just pay me $1,000 a month, listen, there was $28,000 that walked out the door in one week and you ...
Howard: Let's talk about that elephant in the room. What is your consultancy? Is it a contract? Is it a plan? Is it a monthly retainer? How does it work?
Debbie: I charge between zero and $50,000 a year.
Howard: Okay. How can I get mine for zero and not the $50,000? How does that work out? Because really there are listening in this and they wondering how does this work?
Debbie: Well, I'll tell you, we have something ... I mean, it all depends. Lots of doctors want two and three offices, so it's not going to be $1,000 a month. However, we do have an online portal and so I can tell you that for six months of the online portal with working with me one-on-one twice a month and doing those webinars, like I was telling you about, we've got Donna, she's the Glinda the Good Witch of the West, who talks to these hygienists who think they're in the prophy palace and she knows how to walk them through to get them to embrace we're creating longer, healthier lives. That program is $7,000 for six months.
Typically, in a lower-end program like that, our clients have no less than 34% increase in their production within three months. I tell you the lowest one, 34%, within three months was not in the United States. It was in a country that doesn't have attachment to insurance.
Howard: What is the additional consultation? I mean, do they email you? Do they call you? I mean, can they call you? How do they run their scenario by you?
Debbie: They can email me just to talk to me, ask me a question and we do a complimentary analysis. That's where we look at some ...
Howard: That's via email? They email you to get that, and is that debbie ...
Debbie: The support, that's firstname.lastname@example.org.
Howard: Support@dentalpracticesolutions.com. Can they call you or are you for email?
Debbie: Here's my number and they can reach us. I know you have a lot of people just like I do that are outside of the U.S., so call this number, area code 503 970-1122. That's accessible anywhere in the world.
Howard: Okay. Back to these dentists. I just want to get there done. To me, I mean, people like me have used consultants all the time, that's why we're on top of the game, and everyone else, they don't want to do it. What do you think about this question, the dentist says he just wants to do dentistry. What do you think of an office manager? In general, do offices with office managers, are they better managed than without or do you the best ones with the doctor's spouse running the front or not? I know the big thing now is the AAD or the American Academy of Dental office managers. What are your thoughts on office managers, the doctor's spouse working at front? Talk about that.
Debbie: Howard, interesting that you should ask me. In the last 12 months, I've had two doctors who have their girlfriends working as the office managers. Their girlfriends, okay? They're in some dire financial straits because of that. One of the girlfriends was in HR at Target and she's now managing the office and he's paying her $100,000 a year.
Howard: Yeah, but more importantly, is she hot?
Howard: I was just kidding.
Debbie: No, you nailed it, Howard.
Howard: Yup. She's hot?
Howard: Back to that question, in general, do you think offices with office managers are better managed or not really? Or do you not see the correlation? And back the doctor's spouse too.
Debbie: It doesn't usually work very well with the doctor's spouse. I talked to many doctors and I talked to their spouse as well and they tell me it causes friction between their relationship. The wife is usually telling me, "I don't want to do this," and doctor is like, "Hey, the reason why we hired you is because we need help and my wife doesn't want to work here anymore. It's too stressful for our relationship."
It doesn't work well usually. I'd say spouses need to stay out, girlfriends need to stay out. Girlfriends? It causes a lot of problems with a girlfriend. I have not seen it work well with a girlfriend.
Howard: The dumbest thing I've ever seen of all the people in the world, let's say, you're heterosexual, let's say, you're a male heterosexual with 3.5 billion women on the planet, why would you have a relationship with someone that works in your office? I mean, it just doesn't even get any dumber than that. I mean, at that point, it would just be easier to go get a goat or a hog.
Debbie: For you, it seems to be.
Howard: I mean, it's crazy. I guess it goes all the way to White House. I mean, Bill Clinton. Just crazy, crazy, crazy.
They can email you or call you and they can tell you their situation, and you say it's a complimentary conversation?
Debbie: Yes. My husband, he works with me full time and he's a numbers guy. He was, years ago, the general manager for Dreyer's Ice Cream. He's a numbers guy. He loves looking at the numbers. He works very closely with Rick Willeford who's Dental CPA I told you about.
Howard: What does he think about that crisis at Blue Bell where they had some bacteria in their ice cream and literally shut down the plant?
Debbie: He's not with Dreyer's, he's not with ice cream anymore.
Howard: Have you heard of a Blue Bell ice cream?
Debbie: No, I don't think so.
Howard: I want to ask you in the last five minutes. I've only got your five minutes. You said you work mostly with Dentrix or Eaglesoft. I've seen the movie Dumb and Dumber, which is one is dumber, Dentrix or Eaglesoft? Which one is the moron and which one is the imbecile? I mean, they don't have an accounting package. It just blows my mind that I was born in '62, we were on the moon when I was seven, now I'm 52 and a grandpa, with a three-year-old granddaughter, and my computer software doesn't do payroll, doesn't give me statement of cashflow, statement of income. It doesn't tell me when I do my payables and my receivables, I can't log the cost of each room so I know, when I spend an hour doing crown, if I make money or lose money.
On top of that, you're in Oregon, which is in the same state of the only dental software company that has raging fans, Open Dental. Have you met those guys?
Debbie: No. I haven't met them.
Howard: Have you heard of Open Dental?
Debbie: I have.
Howard: They're in Oregon. In fact, I'd go visit that guy if I had to walk there. It's the only software with raging fans. I'm just trying to wear them down to add in accounting package, because Dentrix and Schein clearly don't give a shit. They wouldn't care, they could care less ... I mean, for them to call it a management information software, it would be like ... I mean, it's just crazy. Might as well call them the moon or planet. Forget Pluto, Dentrix, Schein have declared the moon to be the ninth planet in the solar system.
I mean, these dentists will sign up for a PPO plan and there's all these fees and the schedule knows that doctors spending 45 minutes on amalgam, an hour on a crown, and he has no idea if he is making money or losing money. They call into a Schein or Patterson conference call to Wall Street and they're talking about their numbers and earnings and metrics and price earnings and profitability. I just want to call and say, "Dude, why don't you give that information to your customers? How come I can't get into that data on Dentrix or Eaglesoft?"
Debbie: Howard, what do you have, Dentrix or Eaglesoft? What do you have?
Howard: Well, right now, I have Soft Dent which had a different owner ever 16 and a half weeks since I bought it. I think it's owned by CareStream now, I don't even know its makers. I don't even know who owns it. I am this close to switching to Open Dental, but I don't want to switch over now. I'll only switch to the first one that adds in accounting package. I think the guy up the street, he's a real dentist. He owns Open Dental. He's a new doctor. Why don't you go wear him down? In fact, you ought to get the ... what did you say his name is, Rick Willenger?
Debbie: Willeford. W-I-L-L-E-F-O-R-D.
Howard: You ought to go to Open Dental and then we do another podcast with that guy from Open Dental where it would be you and me, with the Open Dental, maybe with Rick Willeford. We can book four people on the screen at one time. This Rick Willeford, do you know how much he would love to have all the data in one place? I mean, you have all your information in peach tree or quicken and then all of that in the supposedly management information. At best you have bipolar, schizophrenic setup.
Debbie: I wanted to tell you something, Howard, DentaMetrix can tell us what the hygienist is making ... I mean, it measures per square foot. We ask our clients, what is a square foot of your office? It goes into what you're bring in per square foot and all of that. It gets real deep into that. You have to talk to me another time because I've some solutions from your situation you just mentioned all the way to your kidney stones. I've got solutions for you, Howard.
Howard: I tell you what, if you go to Dental Town and create all the solutions right now, because we're coming up on $200,000 dentists. Right now we have 199,218 dentists and we're also coming up on a huge metric, we're coming up on a four million posts. If you go to read all the threads on Dentrix and Schein and blah blah blah, most of them are all just complaining sessions. Then Open Dental, it's just raving fans. It's raving fans and they're in your background.
Like I say, I will switch to Open Dental tomorrow if that owner, who's a white blood dentist, he's a real dentist and he gets it, if he will add in accounting package, I'll switch. I think the dental consulting business will explode because then for the first time ever, you can run a report and say, "Dude, here's your PPO fee schedule and we've allotted the costs. We know your office has only four operatories. You have the same five people working there for the last 10 years. We know your [inaudible 01:00:25] like computer engineers malpractice and every time your hygienist ....
There's a lot of dentists who will say, "I have one hygienist. Shall I get two?" They'll say, "Well, on your existing hygienist, every time your hygienist sees a patient, do you make 12 bucks or lose 20?" I don't know. Then you go in there and I have to get Excel spreadsheet that takes me all day to figure out, "Oh, well, actually, you'll have to have seven full-time hygienists to go bankrupt." I can tell them how many hygienists I have.
The other thing that's just so sad is you all these PPOs where, except for maybe a crown or a molar root canal, they're losing money on every procedure.
Howard: They're like, "Shall I take this plan?" Dentists are smart. I mean, these people know calculus and physics and geometry and Kreb's cycle. They're wickedly smart. Then if you show them the data, here's the PPO plan, every single time, Margaret comes into the cleaning, it'd be cheaper to give her $20 bill and tell her to leave. Because I'm screwed, I'm dropping the plan.
If you show them the data, they'll make the right decision. They just don't have any data because Patterson and Schein have decided that you don't need the data.
Debbie: We were able to import that with the Patterson and Schein products and we can tell them what those numbers are.
Howard: Why would you even need to do that? You have to do that.
Debbie: We do that because, I'll tell you something else ...
Howard: Because you have to. The dentists don't have the data. They're completely ... Patterson and Schein, I can tell if they've got dentistry as Stevie Wonder to Ray Charles. They're somewhere in between. They're both blind, one's alive and one's dead. That's their management information system.
Debbie: Howard, these doctors, they are telling me, all my colleagues told me I need to sign up with some more PPOs. I don't believe that's the answer. Then I've seen their numbers when they first come to me, 70% collections and they think there's nothing wrong. They go, "Oh, that's because we have to write it off." I think there's a problem here. A million dollars and you're only collecting 700,000? There's a problem.
Howard: We are two minutes over time. We're an hour, two minutes. I just want to say this, I mean this with all of my heart. I'm your biggest fan. I love you stuff. I follow you on Facebook, Google, Dental Town. I wish you'd make some online CE.
Debbie: I have it. I'll send it over to you.
Howard: Yeah. You know what we don't have on Dental Town? We've got 317 courses but they're all drill, fill, and bill, endo. No one's done what you're talking about, a hygiene setup, perio deal, bonus numbers. If you put up an hour long course or a three-part series or whatever that would be amazing.
Howard: If you go down to Open Dental and get that guy, I swear ...
Debbie: I'm going to.
Howard: ... I'll even hop on a plane because ... I mean, I would fly to Portland to try to close that guy.
Debbie: Well, I'll pick you up.
Howard: We can go get a tooth tattoo because I know everyone in Portland has a tattoo.
Debbie: No. I'm just not one like everybody else.
Howard: Would you agree that from Portland and Seattle there's tattoos and every tattoos [inaudible 01:03:40]?
Debbie: I was shocked. When we moved here, of course, it's a shock. I couldn't believe it.
Howard: Hey, Debbie, thank you for all that you do for dentistry and Dental Town and dental consulting. I know a lot of your clients are raving fans. It's just an honor that you spent an hour with me today.
Debbie: They are. They tell me I follow Howard, I listen to Howard. I'm like, "Hey, you've go to listen to me now."
Howard: Okay. We'll listen. Thanks again, Debbie. Have a great day. Have a great Fourth of July.
Debbie: Thank you. You, too.