Dr. John is passionate about access to dental care and the use of data to improve quality of care. He sees the democratization of data as a focal point in transforming the dental industry into areas of predictive analytics, machine learning and artificial intelligence.
VIDEO - DUwHF #1197 - John Maggirias
AUDIO - DUwHF #1197 - John Maggirias
He spent 10 years as a population data scientist at the University of Toronto, and has owned and operated over 300 clinics during his private sector career over the last 10 years. He also founded Jaw Shield and ClearShape which were dental device distribution companies operating across Canada.
Howard: It is just a huge honor for me day to me podcast urging dr. John Medeiros we're both lecturing at the in Barbados at the Caribbean dental convention is there called sea.
John: Caribbean dental program see 17 years in the making.
Howard: And it is amazing and there's 15 islands in the Caribbean I'm told there's Dennis from all of them I met Dennis from French Gianna Gianna Venezuela surname Miami and my gosh John here had a most interesting interesting warm up lectures about what that 10 15 minutes long.
John: Yeah about that.
Howard: Can we play that at the end of the pot.
John: Yeah I think we should yeah.
Howard: I would love it this guy is amazing so basically he has a Bachelor of Science degree from University of Toronto graduate in 2002 then he goes to dental school and University of Toronto gets a doctor dental surgery and then the the same time he is doing a University of Toronto Research Officer he's a managing partner of a business group then he started a doctor dental surgery laser Dental Center then he was a CEO of clear shape for two years that he was a CEO and chief dental officer of JM dental group and now for the last two years he's been CEO of denta oolitic a-- dental it ago who's like Microsoft but their product is would be Outlook and dental it ACCA's product is been to cloud and so gosh there's so many things I want to talk about where do you want to start look yeah what he was passionate about.
John: Well it's funny my career started at a fairly early age I had the great privilege and honor of working with my late mentor dr. David Locker who was one of the preeminent minds in population health he was an oral epidemiologist and I started my career in numbers and my early research actually in dental anxiety so I got to understand why people don't go to the dentist versus why they do go to the dentist and that was absolutely fascinating and I had the.
Howard: Irritating one implied having one in five.
John: People do not go to the dentist at all because their dentally anxious and so my early career started looking at one of the largest studies on dental anxiety which was a longitudinal study I had started prior to me acquiring the data set and I worked with dr. Locker David Locker David and we essentially published the papal paper in colonial epidemiology and oral epidemiology and the irony was in 30-year down school it was assigned reading so the paper I published when I was 18 years old was assigned reading when I was a 30-year dental school which was pretty cool and what I got to learn there was that you know understanding numbers lets you have insights into how people behave and one of the biggest predictors of individuals not one of the Dennises lack of trust and lack of communication and and and actually my first degree prior to getting into research was in behavioral evolution at the University of Toronto at an undergraduate degree and so I was always fascinated with the unconscious mind and obviously when you look at anxiety it surfaces in the unconscious mind it's not something that is rational it's something that it comes out of you but you don't know why and if anyone's ever had a a phobia of snakes or or any phobia anxiety is part of that continuum and so I was in doing very fascinated with it and that begun my journey into numbers in dentistry.
Howard: So what advice you have for if one inside.
John: Yeah so you know the biggest advice that I have is you know what I do with my patients let it practice for number of years as I you know patients usually sitting in a dental chair and it's usually my assistant in myself and I asked the patient I said there's three of us sitting in this room who's the boss and the patient usually points to me and says you're the boss and I say don't try again and then you come to the assistant I say don't try again and any point to themselves I said yet you're the boss so I say my job is 50% educating even 50% treating you and I said in you're the boss and you can fire me so you're in complete control if I don't do what I got to do you will fire me and I don't want to get fired as you know part of the whole I hate to use it now but I used to it the whole Trump that you're fired right so I used to tell the kids it's fun with the kids cuz they like so I always joke with them at the end of the report I say do I still have a job or am I fired and and I create that element of control that element of communication that element of humor that basically makes them feel like now they're talking with a family member and I treat I say that very very very very genuinely I treat my patients like they're family if I wouldn't do it to my brother and my mother my my nephews I wouldn't do it to them and I think that's really important because you know as you know as a practitioner yourself we usually one of the most trusted professions and I think over the years unfortunately that has started to change and I think communication is so paramount to to ensuring that society truly trusts us.
Howard: You know in my 56 laps around the Sun the one thing i've seen deteriorate the most in my lifetime is trust dressed and elected officials trust and priests and rabbis dresdin I don't want my children alone in any room with a gun and trust has been really do you think dress has gone down in the 14 15 so.
John: It's interesting I think if you you know take a step back and you look at what Trust is created I think and as a society in general we've transformed from a collective thinking to an individualistic thinking and that landscape predominates our society you know it's the it is the me movement is what do I mean what are my feelings what do I eat you know I'm more important I'm saying that's very important because you know I think there's been a lot of clinical manifestations that have you know become pronounced because of a collective thinking and when you look at marginalized populations like you know people who identify is is for example gay or visible minorities you know I think that individual individuality you know has been very transformative and very important in our society reaching to the heights that we have today in them you know we've never lived in a more prosperous time as a human civilization and I think you know we always have to keep that in mind everything is getting better whether we feel that it's not or not it is life is getting better it's we are the luckiest humans to ever have lived on this planet and I think despite what's happened politically that is true.
Howard: I know I mean 1,900 there are 2 billion humans yep and now we're coming up on eight billion and in that time there were two world wars that I killed hundreds of millions and the population is double pass out whereas you go back at the bubonic plague.
Howard: 130 Europe died.
Howard: And it took 200 years to get their bodies back Africa just passed 1 billion people the Americas the whole wasn't hemisphere is a billion Hindus a billion to I mean you're an evolutionary biologist I mean humans are crushing it.
Howard: I mean anyway when you have 8 billion humans living from the North Pole to the South Pole it's hard to make an argument that these are tough times for humans.
Howard: I mean they're living everywhere.
Howard: I've been longer though i've seen a lot of people have a lot of doom and gloom and a sight cat look at the numbers we are crushing it and I like Lester like here in Barbados I bless you all around the world for 30 years when I go back to countries I lecture at 10 years 20 years 30 goes I mean my human psychology and going around of 50 countries over three years everybody's doing so much better but so many people don't believe that these are good times I'm like what do you want to look at the bubonic plague you're in one more one more to the Civil War I mean.
Howard: I mean when people are saying these these are tough times I'm like the Civil War in America one and every 30 people died of smallpox when when the Europeans came to the Americas small boxset wiped out 90% of all the people in the Americas I mean these are truly we've come through so much these are such good times.
John: Oh my big jokin to tie this back to dentistry my big joke is you know dentistry is the most successful medical profession we should all be very very proud of that no one dies in the to field.
Howard: But the reason I was dying to get you on the show.
Howard: Is because when you look at these dentists they're just like Oh times are tough times are tough man like what would it what is scaring you and i've always believed one of my deep theories on human set you know when they asked for a kid and the dinosaurs were killed you know we come from Mice and mice you look at a mouse in a cage manage is just shaking it scared and and all the other top predators like sharks and bears and lions they slowly got to the top being able to kill anything there they have no anxiety they're not nervous a lion will kill you even sleep for three days sure but humans for millions years we're living in trees they're afraid I he knows and fraid of lions and freita Tigers and everybody was going to kill them and they're just like mice they're always scared they always have anxiety disorder and they they they love fear like when you start talking about like when you at a Wall Street you start talking about the whole thing's in a crash like 20% of invessels can hold on I love this tell me more about how the whole world's falling apart let me go to religion 20% you know the end of the world you know there write a name I mean I mean they just feed on fear and then on these on and like say they they they're not sharks bears they they just had something changed in their brain and the next thing they're smart the next thing they're the apex predator but there's still this scared little monkey that involved from a scared little mouse mean go to the store and look at little mice and gerbils I mean they're they're very scared and they're always scared than I asked and I said because I know they're very susceptible to fear and I say what are you scared about what do they say do you yeah we're all gonna be working at big dentals and you know as much about dsos as anybody i've ever met yeah I want to change this conversation too I know what will make them less and all I gotta tell them yeah to get those you're gonna take they're all good like really I'm gonna sell my office yeah a gold and though yeah the earth is falling better but DSO is there what is your opinion of a DI hello if I say you're speaking yeah here just to give terminology yeah we don't like corporate dentistry because every dentist I know is incorporated or now i'll see or whatever but you were saying in your speed set 0 to 8 yeah so 0 yeah there's been.
John: Some some terminology and start create some scope around what a DSO means and and generally 0-8 means that emerging DSO when you get to about eight to fifty you have a you know growing DSO and then when you get to fifty to roughly eighty you call it a DSO and then you've got the mega dia so it was the ones that everyone knows the heartlands the Aspen's the smile brands they're they're the real parts.
John: Of a give yourself yeah then maybe do souls you're talking triple digits you know triple digits I want to say.
Howard: A hundred.
John: Hundred plus Colossus.
Howard: Yeah okay so let's say that 50 100 would be 50 50 to 80 50 100.
John: You know I'm just giving you something right there's no clear definitions for for what a DSO is but I think when you know you start creating an idea of it because it's very different to talk about an aspen dental you as a DSO versus a dentist who owns five practices right.
Howard: Ask - 700.
Howard: Heartland has 900 Pacific have.
John: Oh they're coming to be.
Howard: Was that what's the one in England my dental England.
John: Well there's a couple there's a waste estate merged in so private equities done a lot of roll-ups over there Oasis was a big one there were my nails another one that did a rollup I haven't followed the UK space as much when I was in academic I did a lot more work by Esch in my late mentor that I mentioned earlier on was from the UK he graduated from Sheffield so I was very in tune during my 10 years in that damn akan the UK space but I haven't been as up to speed so I specialized right now in the North American market.
Howard: Okay well my theory for the shows I brought in a lot of ceos and dsos of the the - from australia 1 300 smiles Pacific dental I would say a poor and podcasted em Q&M; dental i've had heartland all their business because my theory is man if you're running 500 dental offices surely might boo one thing got a dentist running one office yeah and so my homies are all over the board they're just have a lot of bird es oh yeah I know a lot of yeah so people are big fans yeah.
John: But what I can point to one fundamental difference that I think will change how your traditional dentist thinks about this the traditional dentists their client is the patient when you're running a mega idea so the Heartland is the Aspen's and Pacific's the coasts your client is your associate because the limiting factor to your success is the ability to keep a dentist who's happy motivated productive efficient and they're not an owner so you know as owners and and a lot of us got into dentistry because of the ability to answer to no one you know you're a big fish in a small pond.
Howard: You mean they're all single no I'm not married.
John: Yeah we won't go there on this one yeah we to us but so so that's a big fundamental difference so you know the ceos of you know the smile brands the the heartlands the you know these are organizations they're very they're built and they're succeeding on the ability to train maintain and grow dentists because that's the limiting factor that's where the if you look at supply and demand and traditional accounting you know that's where that's where your limiting factor is right there are roughly two thousand dentists in you know in the US and all of these you know dsos are competing for those two hundred thousand that's a limiting factor and they're not growing you know that's pretty stable in fact you know Chicago had a dental school that closed down so your supply actually just went down so and the reality is is that you're always our question absolutely that's right and so when you look at the dynamics that exist in the market I mean the number of dentists and graduating dents is a very expensive business proposition so the number of dentists graduating isn't growing and you also have Canadians that come south of the border because we only have dental schools north of the border and you know we're based out of Toronto and we're Canadian firm and so we have a lot of Canadian dentist because we only have ten schools that come some of the border but then they come and practice back in Canada so that actually takes a spot of an American dentist right and so and then there's all kinds of interesting politics about that because of tuition cost and so we won't go there but anyway the bottom line is is who your master is because we all have a master be assured as we're standing here you know the master of us is private practicing sole proprietor dentists is our patients the dsos are there to serve their associates so that's a big fundamental difference that should reduce anxiety in the sense that if you want to be dealing with patients stay to what you're doing if you want to be running a DSO well you're gonna start having to worry about associates and it's a whole different animal.
Howard: But the one thing I think that the private practicing dentist as a DSO is it's not fair at all is when you have five hundred offices you live under a microscope yes and the dsos though they live in a maestro so there are infection control policies there and everything is so much more sturdy because that but when it when an individual dentist does something wrong find out as autoclave has working for three months they don't use for testing and all this stuff the dentist never really anchor to that the gosh-darn is a DSO does it you know there are over maybe screaming in the media and the Venice or i'll scream and all this yeah I mean so they they don't they don't get a fair shake and they live in an aquarium and I got a lot of homies out there I mean that are really good guys but I mean they don't have the protocols for you know all the things yeah shows us but um so I want you to address something you know a lot about and that is the red flag that none of these companies you know public I mean I'm lift loses a billion dollars a year and they just went public whoever's gonna go public they lose two billion dollars a year and I saw this from 94 to 2000 when the internet disco and all these they know what was making money and the stock step doubling and doubling doubling so my point Blake question is how come not one single DSO has done IPO on NASDAQ and it's been a publicly traded company.
John: That's a great question so let's look at the history of dsos okay and actually the original DSO actually as far as I can tell for my readings and I was born in 79 but the one of the original dsos actually came from Canada that's Ronald and it was the company called trynna and tried on was national in Canada they had her buy.
Howard: Another Howard Talley rocket bingo and how is letting dr. Howie.
John: Just as an aside baby how he was such a trailblazer that he was he brought the Royal College of Dental Surgeons to the Supreme Court because they didn't allow him to market didn't allow him to and he wanted he won one of the biggest judgments in in Canada and it transformed the industry okay he was a real trailblaze was that 73 no that would have been in me that would have been in the early 80s mid 80s is when they really had their clients.
Howard: That started where I live in Phoenix that was in 1973 I believe it was so they started in the 70s but they really came into their own in the eighties yeah so in 73 I think was Goldberg and Osburn and they you know dentists lawyers physicians could not advertise them by the way to this day you still can't advertise in Hong Kong and Romania and lots of quite lots of Barbados as well as like that so that it has been advertised and these these look to lawyers and Phoenix fees Simon Goldberg Ellsberg they took it to the Supreme Court they said you're limiting free speech I mean I have the right to tell you so that if you don't brush your teeth you'll get gum disease and when that got turned over in 73 that rolled over to the Russians and then you say that how we rock it and try not did that.
John: Yeah yeah yeah yeah price was another partner but he's the unhappy was that was the department yeah but anyway so what they you know they were very successful and did a lot of great things and for a period of time the majority of graduates from from Canadian from the University of Toronto especially we're working for try that and they diversified they went into other businesses and unfortunately didn't work out.
Howard: And they made it work out words that make sense the new york stock Gina a billion dollar valuation 200 million cells gone right yeah oh let's go down all crab solutely.
John: So then let's look at the eighties in the nineties rather so in the nineties we had some ipos and there were there was you know I think Dental Care Alliance or their their CEO Mitch I think it was part of some of the ipos that happened at that time.
Howard: On NASDAQ.
John: I can't remember where I'd have to go back.
Was the only one ever to be on the New York Stock Exchange investor.
John: Yeah I mean there were a number of ipos that were done in the late 90s but obviously at that time it was more about the tech and they weren't successful but one thing that is sure and this is what private equity has kind of banked on is that dentistry is a very predictable business you know there's a there's a big component of residual income we look at the hydrogen programs and so when private equity how they created the financial tool of dentistry in their portfolio is to protect the downside they're not so worried about looking at the upside well to protect them the down and so when you look at you know one of the largest private equity funds in the world KKR.
Howard: The way this bond Heartland.
John: That just bought Heartland correct you know they had to deploy billions of dollars and they had to park it somewhere and so the sheer size of Heartland made it a very attractive proposition and it was a great article online with Bloomberg that looks at the debt ratios that Heartland has but regardless it's a very cashflow positive business and when you look at traditional accounting you know at the end of the day if you have a cash flow business you know and you're in it for the long term.
Howard: Yeah they go on the periodic table and three elements yeah that's right yeah yeah.
John: So cash flow is the ability when you look at your bank account very simply every single month you have a lot of money coming in and so dentistry has that ability now the hardest thing of any business is to grow your top line and top line means the amount of revenue but when you start to look at what a business truly is you start looking at profit right because you can make lots and lots of money but you're not able to keep it well it's not gonna help it.
Howard: I'm sorry dinner I'm good please no this profit also net income.
John: Yeah so profit yeah one of the biggest things in.
Howard: I don't I never met a dentist that knows that ever seen a statement cash flow a balance sheet and a state living yeah so you got it I mean bad and that's why I love Dennis they want to do surgery um you think yeah they want to perform the best work you know absolutely I love him for it yeah but as a leader I got it take their nose and say a little dentist –.
John: Yeah remind me of a story was that it you know this is kind of an aside but it kind of answers the question was that a conference and you know I was listening I was in the audience and Dennis came out and said hey have you heard of this new thing called even em good and I said I said I kind of wanted to listen so I said I said oh you just heard about it they're like yeah I just heard about this thing eben I'm you know they're paying multiples of EBIT up that's what people are paying and I said well what does he bit a stand for and they said I don't know so it's even a stands for so let's talk about even because that's a great great definition for looking at what properties and its earnings before interest taxes depreciation amortization and the deed yes I got it Dublin backers so earnings before interest taxes depreciation and assets all right organization sir and so when you look at even oh that is a pure profit calculation because if you've bought a lot of equipment like some dead just have that's not a bad thing but that shouldn't penalize because that's there to help your practice so even as a very important number to toss late over time yeah so when you buy equipment you might buy a half a million dollars worth of equipment now you can't write off all 500,000 their schedules and depending on what jurisdictions you're in and what you know different tax laws apply to you you can write off a certain amount every year so over the duration of that equipment you'll slowly write it off but you can't write off all at once.
Howard: Yeah and the reason you need to know that because IO is you're gonna say well a practice sells for basically one year's revenue and that couldn't be more wrong let's say we have two practices they eat you a million dollars and one loses money one makes a hundred thousand year and one does three hundred thousand year well guess what the one that makes three hundred thousand a profit that is a million is worth more than the one that does two hundred thousand a profit where's 100,000 in an office it doesn't make any profit I don't care if it has five million dollars a year what's it worth.
John: Well yeah it's challenging right I mean and then so it's interesting question so that when you have a practice that's making say five million a year and it's got zero profit quote-unquote that's when you start looking at something called normalize deepening so normalized Viva that says if a more astute business person person manager was to take this practice over there would be expenses they can eliminate and therefore a business that for someone is worth nothing to an astute business person that would be worth something so that's how Warren Buffett made his money because when everyone thought something was worth nothing he saw opportunity and he saw things that he can but they jokingly say cut the fat so you know the biggest thing I always tell any dentist is worried about your top-line worried about the ability to make revenue because you can hire great managers that have the ability to help you cut the fat very simply and then that way you'll have a profit that eventually will be substantially higher so when you look at numbers you know and I heard you speak today you know I'm sorry here that he's a great speaker I'm sure you all know that though so when we look at numbers you know if a practice is running at 25 to 30 percent profit that's an excellent practice and when you look at a traditional DSO because they have a lot of centralized overhead they're probably running at closer to 20% so as an individual dentist you actually have the ability to run at a higher profit margin.
Howard: But looks like that I'm gonna be a lot of dentists will say they mix a profit from having capital employed in a deficit job so they'll say yeah my overhead sixty-five percent so I make thirty five percent profit I mean well did you work for free no no I took all that okay well if I took you out of it yeah I'd have to put a dentist in there and if I and if you had sixty five percent overhead and I paid the dentist 35 percent of collection there'd be no profit dollars.
Howard: So they always mix the profit from having capital employed in the dental off yeah versus the income they may have from having a doctor dental surgery absolutely.
John: So when you look at what normalized II but the Assumption there is is that when a DSO buys you they're gonna hire an employee so your normalized even has to account for someone replacing you and then profit being there after you've paid yourself so that's very.
Howard: Where does the average DSO pay a dentist or how does.
John: Yeah you know depending on which state you're in I think on the low side it's 25% of collections and on the high side I think it's 35% and then you're getting a specialist that gets at 40 to 45 and and what is what is the difference thing I mean I pay my 25% what what is there is in 25 and 35% I mean there's a supply and demand is it the same yeah I think I think it's a function of supply and demand it's a function of what clients how the practice has if you have a practice that's doing substantially more crown Bridge you know you could probably get away with paying a slightly lower percentage of collections because the production of daily is gonna be higher right because your per hour time in the chairs worth more so I think Dennis need to evaluate that and if there's some cracks in ER look spend and they're evaluating how to bring an associate want to pay them I think they got a look at what is the going rate for a Dennis so for example the analogy I use is say a dentist you bring an associate in and at the beginning you only have say three thousand dollars of production well you got to do the math you say well will a dentist work for me for for paying twenty five percent while they worked for you for seven hundred fifty dollars a day.
Howard: And they will and big urban city sure and they want.
John: Exactly and that's the other thing right the percentage is you're gonna pay depending on where you are geographically will also make that decision but the biggest thing that I say is you know you've got to look at your colleagues in the area and and you know Dennis in the neighborhood or in your you know five kilometer radius will give you a good indication of what they paid their associates and what's responsible for you to do to be responsible to your business.
Howard: But I love you said that and when you're a private practicing dentist the client is the patient when your DSO is the client is a dentist you got a train maintaining grow but the Esso is get a bad rap for it but I see a dental associates am pregnant and BSO's I see the employee turnover I mean it's very high.
John: Yeah it's the biggest challenge I do yes those have.
Howard: How how long does the average dentist work for a DSO or an associate in general man I had lunch the other day with a woman innocent Phoenix she's never worked for DSO but that's go five years work for five different deaths for five years and i've always said and I'm not joking dentists make horrible employees.
John: Sure yeah I think I think it's interesting I mean why do you have a very highly intelligent employee right so they're they know they have options they're they're empowered because of that intelligence I think the other big factor that you look at this all I want to touch on this later on the way you know work it'll dental it because a data company and so when we look at things we look at it from a very numbers oriented standpoint and so you know what we say is we talk dentistry through numbers and you look at the feminization of the profession currently you know three you know 70% of new grads are female okay that's a huge what percent 70 percent of the new branch of female.
John: Crossing America across North America North America United again that's what the latest census data show now you'd have to follow their.
Howard: Podcast the one before you was for women dentists that all graduated in Saskatchewan or Alberta.
John: Yeah yeah and so the feminization of the profession has been transformative and that actually mirrors the University and higher level education in general but so that's an interesting thing so it's a kind of.
Howard: Common evolutionary model yeah why how do you think I'm women different what women has to be different than male Dennis.
John: I think there's a lot of things I mean you know I even haven't been a male I think females tend to be more conscientious I think they tend to be more empathetic I think they tend to be I mean I I don't want to get into this whole gender biasing know this relation but Tommy but you know but I think what it comes down to it I actually think females make better associates in general I don't necessarily you know I think that's true all the time but I think is a you know as we generalize I think they do because.
Howard: I think they're better humans.
John: I think you're right I mean like two mills have a problem what do they do they go right device yeah you get out yeah and what do women do they shout it out yeah they women do this always complain to me will you know I I work for this man for five years needs to get me probably do then and everybody would jump and I bought it from now they all come to me and and tell me you know they don't want to do this for always recently they like you they were afraid of that guy yeah yeah and then they know you have empathy yeah communicating with though and you're pissed off because you just wanted to fear you it's a conjugate point that they all feel yeah yeah a lot of a lot of staff does not feel safe around the dentist and i've been lecturing for thirty years so I kind of said we talked about this I don't see what is your dentist oh I never asked my dentist that I think that's just.
John: Yeah yeah.
Howard: No it's how can you work for a doctor yeah ask questions.
John: Well there's even a bigger problem we've talked about there how can you work with someone that you're afraid of when they're healthcare professional that's a whole other discussion man half but I think you know when you look at females in general I mean they tend to leave more balanced lives than those guys know where and it goes back to hunter-gatherer type of thinking right I think women and again this isn't true for all women but a lot of women are you know they're motivated to have families more than guys and and and and I think they like that balance in life and I think we might like that.
Howard: I would think the one would be better my kids.
Howard: I'm gonna feel safer yeah I'm telling you oh man I feel yeah I would be safer to say well what if I don't want to spend a thousand dollars whatever you know what am i off here where is the man you're just sitting like okay yeah you're the dog these are view points yeah or the doctor.
John: But but fundamentally you know I think when we even take a step back from that even you know we start looking at culture and you know when you look at what's happening in the world in general and and this individualistic notion of self you know it's difficult to create culture and community and and unity and so I think a lot of dsos are now investing in that they're investing in the ability to have culture which is a different challenge and a dental practice will have okay so I guess you know here's you know coming back to our original discussion what we've been talking about over the last couple of days as we you know kind of navigate this conference and through the various speakers I think one thing that I can say that with certainty is that if you don't measure it didn't happen or you don't know what happened okay it's the whole philosophical argument there's a forest and a branch falls in the forest and fall if you weren't there to see it well and that's what I talked about with numbers so one of the biggest things that I can encourage any dentist to do is measure what you want to achieve and target setting and you know forecasting and knowing and Road mapping are so important to success.
Howard: But they don't they don't their franchisees yeah nonprofit American Dental Association she's proud of the fact they don't make profit if they would have bought a mcdonald's they would have had a franchisee that the cash raters connected to the accounting software and at the end of every day when I was 10 years old to 20 years old working my dad the cash register which was NCR master professor they got rolled in nightmare - ready fruits a day at $1,300 and you spent this is your 18% up early agree at a 31% these dentists have dendrix Eagle soft and soft then and it's not even connected to any accounting software and then I go in there and their accounting software is separate so they have their dendrix over here and then they have quickbooks Pro over here and like you that's what yeah I mix books was made for an individual and and then you look at a sophisticated accounting like like ham peachtree is bought by saying sure Microsoft bought Great Planes ago there's how many dental practice manages software's merged with Microsoft Great Planes accounting yeah but they but they they merge with Windows you know and so when you're talking about numbers I can tell you i've been a dentist 32 years these guys if they would have bought a mcdonald's a subway or fried chicken what software would be there.
John: That's exactly what we did yes okay be Wonder so one of the things that we did in analytic and having own you know hundreds of practices over the years and having been in this space we developed the software to address these concerns and so identity because core product is is dead cloud which is a SAS based software which stands for software as a service and we charge a monthly subscription for us to a papaya arranges firming as low as $100 a month and they can get up to $2,000 a month if you get all the bells and whistles and we have an ala carte offering so you can choose what makes sense for you and predominantly we've been working in the GSO space and with private equities to identify practices but what we're finding is that there's now an appetite in the traditional practices to start understanding things better because you know what at the end of the day we live in one world and you either evolve are you perish and that's a consistency that is our reality and you can either face the music or you will face the music because the one reality exists and so we're really helping individual practice owners and dsos alike do you start to understand their numbers start to understand what it means to be successful.
Howard: So so what um tell go into more detail so there's a lip denta i'll let it go don't let it go yeah then a lot of cases main dental cloud as a product it's a hundred do you think it sounds good.
Howard: You think sounds good.
Howard: The band bother you.
John: No no no this abandon bother you.
John: We're in Barbados soda no our mate have you gotta go in it's part of island life.
Howard: Yeah but um um what what numbers are you tracking.
John: Yeah so I think you know we have three core dashboards and one of the core - words we have is financials we then look at scheduling and we look at patient satisfaction so if your numbers if you start dating you yeah we have some financials financials scheduling scheduling customer satisfaction those are the three core dashboards that we have.
Howard: I'm not texting my mind my voice I'm actually taking notes.
John: Yeah you got so financial financials scheduling and patient satisfaction and then what we do when when you log on there's three things that you see that are based on these dashboards you see a grade which is the great of your practice you see the worth which is what your practice is worth based on traditional accounting metrics and then you see your value so the value is what we create for you so we've spent a lot of time talking about numbers and analytics and denna cloud which is our one core business we have three core businesses and so we call it a B C so analytics is our eight and that's weird any cloud is B is our brokerage business so what we do is we consolidate practices and bring them under the dental cloud platform so essentially you have a I call n legs and then analytics so it's a b c so analytics brokerage consulting because there are three divisions of our company and so the analytics is our core because numbers are and language and we talk dental through numbers because you know it's funny because you have all these different software's right you got den tricks you got eagle Seif you got open dental you got Planet DDS which i think is an incredible piece of software while talking about that.
Howard: You want to talk about that now why did you like plan idea well like planner DDS the most.
John: Yeah I love planning EDS because planet DDS has innovative ways of approaching the evolution of the dental market and there are cloud-based solutions so they're also SAS based so software as a sorry yeah software as a solution so software is a service story and and what they do is you don't have any upfront costs you just pay a monthly fee okay and so I think dental Khan which is their software which is owned by Planet EDS is an incredible product that makes it very easy to integrate in your practice and it also gives you access to numbers and we're in discussions to certify and make Planet EBS a debt Akkad Certified Partner and you know what that organization has done is they were doing cloud computing before you know pretty much anyone they were definitely one of the beginnings company but what they do which is amazing I was just in San Diego at the ad is so and they brought together all their users their doctors and they listened they genuinely listened to their challenges and what they need and they evolve the software for them and they have a dent account summit it was just so impressive they have a family oriented environment they listen to their doctors they grow with their doctors they empower with their doctors and it was just incredible to be part of it I had a privilege of joining as we as we look to the game with their their certification process but to go back to what I was talking about so you know analytics is very important and so what we do is we focus just on analytics so there's you know practice management software will be all used it's what we all know that's the den tricks the Egosoft the open dental the planning yes and that's practice management software what we do is we just focus on what the numbers are telling so we essentially translate so every single software collects data in a certain way when we do is we make it all talk one language and we do that through numbers okay and what we basically create is summaries within each of these dashboard for proven systems so we roadmap success and what we do is we kind of said well there's a lot of software out there and you know dentists want to be in the mouth because that's where they make money you know they if their third performing treatments they're making money so they don't want to learn another piece of technology but they will learn a piece of technology if there's enough I guess growth if there's enough benefit okay and so what we did is when we decided to say what we'll then a cloud do so there's three things it does one it shows you you're great we all you know being dentists we all have to get pretty good readers and analytics to their brokerage so it's all part of the analytics is the software Democrat so we knew i'll get to identified you're gonna see you're great you're gonna see your worth you're gonna see your value so right now you know dentists spend a lot of time looking at their portfolio on their phones and guess what your biggest asset is a dentist as your practice and so you should be watching your biggest asset every day and your portfolio is not that so we thought well what will help them what will help them engage with the software and make it part of their lives like remember the first time you use windows.
Howard: Yeah windows 95 windows 95.
John: How fast did you learn it how many times did you swear using it yeah right so there's a process no matter you know Microsoft spent billions of dollars making Windows 95 and it still was a process for you to learn.
Howard: Everybody under might cd-rom bigger.
John: Yeah right buddy there's all these consol exactly - you get word yeah exactly right but there was there was an investment it was a process so data is now going through that Reformation and so what we decided to do it you know I'm a Canadian and I'm a big fan of Wayne Gretzky so Wayne Gretzky was a great player because.
Howard: This is my city Phoenix.
John: Featured us and I was actually part of the the Coyotes as well as an organization coyotes for a while this one worked well he was yeah yeah he was so so Wayne Gretzky was the one of the greatest athletes that ever lived because he went where the puck was going not where the puck was and so we pride ourselves in that a dental Innoko we kind of want to be where the puck is going not where it is today and we're all starting to learn this language called numbers and you know when you look at mathematics most people are pretty intimidated by it so math calculus so you know finite you know all the algebra but really it's the only human universal language that exists and so we can all communicate we all want to be understood there's a fundamental and maintenance in us don't want to be understood and so if we can have a platform that we can understand each other it's numbers and yeah it's not sexy it's not romantic but guess what it works and we all want things that work you know and so when we conceived of creating analytic out you know we said what are the most important things if you look at the emerging trends private equity is gobbling up practice at a faster rate than ever before okay and everyone's talking about what their practice is worth and in real estate we have the MLS the Multiple Listing Service right and everyone knows what their house is worth but I mean when there's a hot market how many people go and checking my house is worth X right or Y well you can't do that with a dental practice you gotta use different brokers that don't sell you stay co-op quite frankly they don't know what they're gonna sell so how do we start to standardize and how do we get people to know what taxes are worth and so we're collecting data on every single sale well going there were were part of a lot of these sales and so that's our brokerage and our virgin acquisition every once in a while about three or four times a year we bundle practices together we shop them around so even though that all 30 or 40 practicer or 50 preps are not owned by one entity because they're all on the same platform data cloud and allows them the ability to sell for more than they could on their own.
Howard: You get a higher even aa second 10 million dollar an office that you wouldn't that's right that's right so so these dentists when he's on denna cloud if they were let's say they're old not not like me I mean I'm very very young that's why I have diabetes and diseases and so if someone was at what age do you think that is start thinking about like what is my friends worth what does that start coming in.
John: You know it's funny I think nowadays with Millennials everything is changing right they have different life life I guess goals and plans so we say that you should always know what it's worth.
Howard: Somebody today was saying you should always know where is he called it the DS cuz you never know where you're gonna get disciplinary or disqualified lose your license dad divorce disease dying yeah and you might think you're 40 years old and I'm not gonna retire to under 65 when you get in a head-on car wreck and they say you're never gonna practice again our.
John: Disability insurance.
Howard: They're doing i've never had disability yeah I never bought I didn't I'm not recommending that I just I did the reason I didn't get this really excites under myself well worst case scenario you lose your eye you lose your hand you can't do dentistry well I I have to do something 12 hours a day seven days days I know I know I wasn't gonna sit there bless your shot so I never paid for because I knew I can do that but but I think it's pretty interesting that you know a lot of these dentists like say every day they're checking their stock portfolios on their ETF or whatever other there is love to stock and you're gonna make it valuing their bracket.
John: Which is a previous asset and then the other thing that we do is I'm obviously is it getting a grade you know you know what do we do when we were in school if you are an A+ student you didn't get a tutor but if you were a C+ student you know you got a tutor and so then the third part that we have is our.
Howard: Consult my mom this is getting too close to home I need my mom.
John: So we call it our tutoring service which is affectionately known as consultant and we have six core products we have four growth products and to profit products our growth products are hygiene Plus which is the core of any practice but actually use go one step back so marketing plus is our core is I consider it a standard product not a core product because marketing doesn't make you money in and of itself right you got a bill to make money but it's something that has to be there it's a standard you just you know you got to have a website you got to have a proper sign you got to have a community presence so these are the three things website sign community presence those are core values that we help build in any practice we consult with then the the revenue generators are your hygiene plus because you know if you don't have a practice that's doing twenty five to thirty five percent of your revenue and hygiene you got some soul-searching to do from a business point of view because that is opportunity lost I got Dennis to tell me that they do their own hygiene they're very proud of it it's interesting.
Howard: What do you what do you think of that.
John: It's interesting I mean I think I think you know again no judgment but if you're running a business you got to value your resources and your time an opportunity cost accordingly you should be building your practice up in such a way that you are doing crowns and bridges you are doing implants you are doing higher production unit time stuff and.
Howard: You go to some countries and they you're crazy American like see you more yeah the whole country is Singapore doesn't have a high dentist.
John: Maybe you do their own lab work in India I'm never meeting guys to do their own lab work they spend time with.
Howard: I remember the first time I left her did not I think it was Singapore and Australia back in like early 90s and I you know I always doctor whenever I go to foreign countries I like to go a day early and see the locals because you know you wouldn't know where they're at and I remember getting laughed at in Australia they're saying ah this guy says they all had one chair I think oh so you have to cherish so you do the Americans do work and I was like this you do too many hours at once I mean they didn't even get on on them operational logistics like well we're seating this pace you can be cleaning up this patient and but now Australia you know I mean the first the first two times I went there they didn't even have a hygiene school.
John: Yeah yeah I remember buying a practice from an old debt it was 80 years old and he was so practising and he'd being that an assistant he did to Hannah dentistry yeah I mean I I remember being in dental school and you know looking for who was on the floor to help me assist cuz I knew made me go faster you know efficiency is a relative word in right.
Howard: In cultural.
John: And cultural announcer and so again I mean what we're talking depends on what your goals are if your goals are to increase production if your goals are to treat more people so I mean there's two ways of looking at it but I look at someone making more money I'm saying you know for the most part you can talk about a vegan ethical but for the most part they're providing more services they're helping more people that's why they're making more money if they do it over many many many years you now know they're good dentists because they're doing for a long time and they're helping any people when you look at access to care you know the ability for you to process patients increases the ability for people to have services available to them and if we're talking about the supply of dentists not increasing in proportion to the population you know by some measures you can okay you know at the end of the day your ability to produce more services is completely indicative of the ability to offer access to care to your population everyone always thinks of access to care as a as a socio-economic marginalized issue but access to care you know you could be the wealthiest person in the world if you're terrified and you're part of that one in five that's an access to care issue because you haven't bridged your healthcare team or a public health hasn't helped you bridge the gap to go and see you Dennis and that's an access to care that you.
Howard: Yeah and that's one of the reasons I'm really worried about the app putting people to sleep mhm because when you put someone to sleep you don't treat the anxiety that's oh yeah oh yeah you might even hate it yeah I might even hate it how's that.
John: Well you might hide it because they're there they're losing control right you have to put them to sleep they don't put themselves to sleep in our research what we show is you got so you know when I talk to early in the interview I talked about what's the first thing I do with an anticipation I say who's the boss in this room and no try again so it says you know try again there you go and at the end of the day it's very easy whoever pays the bills is the boss and I say I also tell them the other things they're very anxious I say it is an honor and a privilege for me to work on your real estate I said it's not a right I'm asking for permission you know here's what I gotta do I gotta fix x y&z; I gotta do a to 5mo I gotta do this in yeah and they generally.
Howard: That's part of a core America is very behind Ireland England in your very many Scandinavian countries they don't want it putting the sleep they want to treat your anxiety they want to talk it out they want to build a relationship they want to build trust and they want to try to get to why are you afraid to the demo sermon that he makes sense the guy is sleeved and as you know how many how many how many needle bricks are in a tattoo they got a pierced ear there's time you got a thing in there deal so then they didn't have to get knocked out for all of that stuff so before you just go start now we're just gonna knock you out well no you're a doctor it's a human you need to ever talking about why or you have this anxiety ya know sometimes it goes all the way back to childhood and they don't even know why they have it.
John: Yeah I know absolutely so part of the biggest thing so when we look at our hygiene programs so going back to our core services like a lot of people coming into a regular hygiene program is they're not explained why do you need a three-month program money to four months six month of nine month some people can probably get away with having a cleaning once a year so that's part of communication that's part of building trust and so we develop these we develop these communication parameters where we work with them and then we follow it up we look at it you look at opportunities we look at what they've committed to and those are followed from right how many times do you sign up for the gym sometimes you signed up for the gym.
Howard: I mean I got a gym membership my whole life right.
John: But the gym membership works that you got to pay your feet if you don't show up they still get paid or no let go.
Howard: I always going good for me three years.
John: Every three years yeah every third year so I mean in dentistry it's different right because in dentistry you know they make it have insurance and they can convince about three months or four months or six month or whatever program they commit to but they don't show up we don't get paid so obviously it's been a communication breakdown when they don't come in and so that's a failure that's a failure as the movie says we got a failure to communicate right and so what we got to see is how do we help our patients understand the importance of regular periodontal scaling root planing and how do we communicate that our hygiene team to do that.
Howard: So you're doing that now so you have so you have you have a company ABC yeah and it's our analytics brokerage consulting yeah so the analytics is the desert cloud right so let's go back that so let's say they have open dental I'm going to be selfish this way yeah so they're open dental and I do all my accounting on a sage yep which used to be Peachtree yep I tried to get my staff to go on Microsoft Great Plains because Microsoft's a bigger brand name and I thought I should be doing this big brand name but my staff that they're like Howard we don't we don't like it you know exchange their day they like sage so so this dentists they say is on the most common is probably what dentures.
John: Don't use is probably the number one software in America yes.
Howard: And what's number two you think.
John: I would probably say Eagles soccer fans against.
Howard: And then what would another three days.
John: I guess then you get it to flip a coin territory so you know in there would be the you know open dental commerce practice works a lot as much you know I would look at all kinds of yeah it's a you know you got there's so many I mean yeah so yeah I'd say.
Howard: Let's say they have one of the yeah does it yes and they always used and they always use quickbooks cheers I guess that's the only number one I guess they they bought books books when I started a lemonade stand when they were five and if you're a DSL running clothes.
John: Know but they all have enterprise level stuff.
Howard: Yeah but but but these dentists aren't gonna be able to scale to none right no my homies like myself I live one office I could have got the DSL router definitely in time yes but it made to a million surance but I'm old school and I always thought you know dentistry is a doctor-patient relationship.
John: And you you save her death and that's what you wanted to be.
Howard: Yeah and plus really look one side that that's what I want to do I to manage ten dental office and determinist I have a hard time managing my own patients my own staff.
John: But I think a lot of young dentists you know have this dream of being a DSO owner without knowing what that I thought you mean.
Howard: But what is it demagogy so identical I would have said if I had Hendrix and.
John: Yeah so if you only say old to practice if one has been tricked someone has open dental for argument's sake right what happens is we so indebted enteric stocks one language you know open dental toss another language and so what we do is we bring them up into the cloud into tentacle out and we make them talk one language and so we create primordial data so what does that mean primordial data makes us grab the number of new patients it creates cells which has specific numbers which are measured we then have developed algorithms so what are algorithms algorithms are ways to that normalizes how things are so for example you could have an algorithm that predicts the revenue for the month and you can look at various metrics that consistently predict what your revenue is so we would measure that and so that would let us forecast okay so we have algorithms and it's kind of like Google what are algorithms right like when you go on Google here's the best way to put it well you go on Google and you say I want to buy a new you know I want to buy you know car and you put in parameters for sports car and x y&z; Google finds things that you would be interested in because it profiles you and it creates algorithms based on you and so kind of what we do right so what we do is we have algorithms that predict success for a practice so I jokingly tell people when they say what do we do we say well Google best for you to find the right product we do for you to create a successful practice all right and that's what denna cloud does so what Google is to the consumer data cloud is to the practice right and so then we give you a grade and we want you to follow the footsteps of proven roadmaps the success and we help you along the way so there's questionnaires that you finish what you started complete when you first log in and then we help you achieve those goals now if you can do it on your own or great just like when you learn calculus or maybe you didn't learn calculus but economy.
Howard: I was actually sure Isaac Newton's teacher.
John: There you go hold on there you go so if you got a good grade well you didn't need tutoring so then we what we did is we basically create a consulting service so we actually started consulting that's my background was that a researcher and I was in the consulting space and so what we did is we basically help you to are you to help you get to your success and we have different programs that you know usually they're about 12 months so we tutor you for a year and then the goal is that we get you to a point that you can be successful on your own the brokerage part of it came in because people will start adopting something if there's enough of a carrot I jokingly say carrot but everyone wants to know what their practice is worth so that's a starting point for you to use the software it's like word what's the first thing you learn how to do in word well you start typing then you learn how to bold something you don't underline something you learn how to print something so we wanted something there to make it a sticky product and at the end of the day everyone wants to know what their biggest asset is worth that is an absolute reality and I always joke and say say you put 10 buttons on this wall and one of them was you know how happy is your wife or your partner you know where's your next vacation etc etc and you put what is your practice worth they're all going to click on what's your practice worth right yeah.
Howard: And another thing some of the some of the I mean I had a monthly column in dentistry since 1994 i've lectured a thousand times so I get a lot of really scary phone calls like my husband just died and some widows talking with four kids she didn't have a clue yeah I mean it's Thursday night I mean she cancelled baseness tomorrow but if she was on this she would be closer to liquidity would.
John: Absolutely she there there's a constant and they could actually there's a water there's a constant liquidity event that they could expire on liquidity so they're putting means the ability that that has no cash value tomorrow and to making it a cash value tomorrow so.
Howard: Never let your money get too far from cash.
John: Bingo and so the idea is is that you can have a house and it's worth something but until you sell it it's not cash so you don't know what that house is worth until you put it on the market whereas with your.
Howard: And you only got one person's opinion.
Howard: You called this realtor because you got that buyer in church so you hope she's good she might be the worst realtor yeah in all of Arizona.
John: So when you're part of data cloud we're constantly evaluating and creating data that shows what practices sold and as we grow our client base we're going to be able to be zip code specific postal code specific in Canada so then that way like the MLS you know what you're worth and and.
Howard: So so are you a Canadian player or you.
John: I think we're both I think right now we have a much firmer grasp of the Canadian market because of our origins we're continuously growing our footprint in the United States and so we we fully anticipate to be have full coverage across North America we have some strategic partnerships that were continuing to grow and as time goes on I think we're gonna have the ability to offer a consistent level of service across all of North America.
Howard: I can't believe we went over an hour and then I want to start now I'd like to play you're injured deer turkey knows you you open this convention yeah with or what at 10-15 minutes me yeah well.
John: 7 to 10 minutes in the future how could you teach my home use more.
Howard: Yeah I'd love to you know I'd love to come back and start talking about some of the basics of numbers you know we all learned how to add and subtract and multiply and divide before we start to learn how to do algebra so I'd love to get into what our analytics what is machine learning what is a I know we didn't get a chance.
Howard: What would be the best way to teach my Dennis i'd.
John: Yeah I think we want to get into some of the basics and start looking at scientific in their practice.
Howard: You think that'd be an online C course.
John: I think that'd be something we should explore and I think that would be an amazing opportunity.
Howard: Yeah I mean like say like you don't have to motivate a dentist to go learn how to do Invisalign or can't care or if it says it he gets it if the course has the word occlusion in it oh my god that flight a pinkie and spear the Ross master is there any way you could have occlusion in the name dent occlusive nothing out and that's why I love my homies yeah I mean I love the fact that they love their art yeah I mean they they do surgery all day was sure hands and opera I love.
John: The sculptures.
Howard: Yeah me are sculptors yeah yeah but i've got to try to get them to do the dirty numbers yeah and and they just don't naturally and I mean like like I can go into a room of a thousand dentists and just has two basic vices like okay we're in April for the first quarter how many incoming calls did you have.
John: So that we have technologies are like not only so we have technology on densa Club that actually looks at your phone calls that reports your phone calls.
Howard: Which i think is the most important.
Yeah so we have that a bit important do the dsos thing becoming a hotter per second I mean I never said it's it's Pearman thank you tell you not only but not only phone calls not only phone calls phone calls is you know that's the traditional emails text messages facts as they track it all they want to know exactly what is happening with their practice and again if you don't measure it it didn't happen yeah so that's very important.
Howard: Yeah yeah everyone's never like I got four boys if I call to UM immediately denied with a full of texts up which means what's up yeah so I always said there think why do these two boys want to text me and the other two boys wouldn't want to call me same thing with my staff yeah somebody's that I'm not I just want a facetime cuz I'm a visual guy and I mean I got 50 employees and there's a lot of they're not want me to see there yeah and I don't know if it's there at home or their you know their what whatever but yeah so people are very complex yeah are very different some are textures you have another summer phoner.
John: Yes and I think that's the biggest thing I think what you're seeing is one of the fastest growing trends is texting I think and what's great about that is so we can talk about this so beautiful spend more time but you know we work with Stanford University we have a flagship program that we're building we work with creative destruction labs out of the university it's rano so if you want to just a couple of teasers for hopefully our next podcast so we have a group out of Toronto that has written machine learning code that can diagnose an x-ray with one click of a button and you can see decay you could see pathology you can see all kinds of things so you know that's pretty powerful stuff so you can get a second opinion you could also have you know the ability of a patient to basically subscribe to the service so a lot of radiologists are quite afraid of you know their future being replaced by behind this what I know this one they go.
Howard: For the history of mankind we've had the same argument that when they came out with the UM with the what was it the the in England when they was making the whoa no would've bursts are halfway there textile mills sick suction oh my god you know abbiejean the the kanji yeah the cotton genie I mean every time when the continuity came out is gonna destroy all the jobs and the horses popping cars Henry Ford was a big book done and you know what you're always trying to protect a job that you don't want like you're you're afraid of like I'm an automatic semi truck driving across the country well did you want to drive a semi across the country yeah I'm a tractor yeah a farmer you know boring it is to drive back and forth and eight hours a day planning in here you're always trying to protect something that nobody wants to do and when you and you automate that job it increases your productivity and no one would be a dentist 300 years ago when everybody was doing agriculture right now that you only have 3% of Americans growing all the food well we got to be able to leave the farms and become dentist and hygienist and and if we all had to plow the field of the rake the funniest story was a Milton Friedman caterpillar lost an account to India because the new Prime Minister of India doesn't know economics and he cancelled all the equipment orders but he said I got a billion people they need job worker so they hired on Friedman send them to India and they said what's up you said well well these people you know if they buy a tractor it's gonna get rid of all these jobs but if they're doing it by a manager then we'll have lots of jobs in Melton said well if that's your theory then take away their shovels and give them spoons.
John: Well you know it's interesting we started this podcast talking about how we are in the most prosperous of times we know the people and the reason why is specialization you know when we were hunters and gatherers everyone did everything everyone you know it's the old same you know how was it how's the saying go jack of all trades master of none and and as we started as primitive cultures that's what we did we just did everything and as we became more and more specialized we got to have cities and we got to have more productive more productivity and so we have this great lifestyle this quick great quality of life as a function of our specialization and different people are talented at different things you can't do everything all the time and so this specialization it's kind of like a body right if you look at our organs we're all medical geeks right you know the liver does one thing very well in the heart another thing very well the brain does another thing very well and as a function we have a human and we exist in this homeostatic environment as a function of all our organs working together and that's exactly what society is society is the ability to have different you know organs quote unquote different members of different segments of different industries Alcoa is cohesively working together blue collar white collar and on and on you can go and talk about this but we all function more efficiently because of the ability to have a division of labor and specialization of Labor and that's what makes us great as as a as a as a world as a as a population and it's amazing though I don't have.
Howard: So what site should they go to learn more about you.
John: Yeah so our main website is dead oolitic accom yeah densa lytic a duck hunt.
Howard: There it is denta if there are no youtube they'll see that but they're on itunes identity ent a little whitey I see a doctor let it calm.
John: Yeah and they'll be able to access our three divisions our analytics which is data cloud they can log in there if they have a subscription will be launching data cloud 2019 at the Ontario Dental Association which is the largest dental conference in candidates the Superbowl of dental conferences I jokingly say in Canada if anyone wants to come out its May 9th to 12th I would HIGHLY encourage you guys to come out we'll be releasing data cloud 2019 are our latest and greatest of software offerings and again we you can also access our brokerage division you can get in touch with other people you can meet some of our team but and then a consulting service is a gateway we operate across North America so by all means feel free to reach out we'd love to hear from you all.
Howard: And his name is dr. John Medeiros yeah is that Greek or Greek.
John: It's Greek in origin absolutely I spent a big part of my life over and proud proud heritage and.
Howard: Any relation to Socrates Plato or Aristotle.
John: I think if we go back long enough hopefully hopefully by the bad-word farmers I you know I came from a farming background so who died was.
Howard: It was an honor to podcast pleasure.
John: Well absolute pleasure thank you so much thank you so much.
John: The deagle protocol already being established by dr. Eastman I know take over although I think Thomas Eastman has really given us a real idea of what we're here for and what he believes as dr. Eastman it's a Native American to experience we're both passionate about continuing education development and rule within our profession my duty this evening is to be master of ceremonies and I will be doing that obviously to make sure that the unit continues to run smoothly but I will say off by saying that in this book I read about my American Surgical Atul Gawande it's called better at looking never edited and one of the phrases that stuck with me when I read that was better lift is a perpetual labor and as you spoke about betterment the reality is is that we're gonna have to be always at it if it is a colleague and there many of us who come here year after year who believe that that is part of our existence where we're constantly looking for better our chart of course is to spread out through our profession and allow the others in our profession who are not here today to may not be here to speak to understand that first improve we have to do it together it's no point ten of us coming here either 15 of me here we all have to walk together if we really want to improve this profession this evening we're going to have a dr. John mcgarrett C is the CEO of dental analytic that he's going to be giving us some remarks I met John a little while ago and he nice insight about his company and he is a very interesting company using data and data can be very overwhelming for the any of you who's that any statistics or analytics and have nightmares about programs like SPSS as I do sometimes data can be a little bit intimidating but those of you who like data and use that data to really help solve problems and come up with solutions in ways that are faster than it takes if we try to work it out and make several misdeeds normally it seems as if John's company has a capacity to do that his company uses data to improve access to quality here and also to create performance driven solutions so I really look forward to hear from John and hope his data can help us make better decisions dr. John makers are we yes dr. Eastman and fellow colleagues I am honored for the opportunity to share a few words about the changing times of Dentistry as dentists we are gatekeepers of the body and we need to be guardians of the profession alike we are on the dawn of a truly transformative era profound changes that have not been seen since the Industrial Revolution are upon us the majority of my life has been spent in the Information Age but we are now emerging from the information age to the analytics age predictive analytics machine learning and artificial intelligence are in the media all the time and this and these items will completely transform our world and dentistry as we know once upon a time we looked upon the heavens to ask questions that would understand our fate today we asked Google Siri for Alexa ironically they are also up in the cloud there are vast amounts of data in the cloud with ever-growing computational power the calculations are growing infinite in multitude and the answers we need are found through this data think to yourself how the Internet is now part of your life think how it was a part of your life 10 years ago those changes are rather evident look no further than your smartphone and what it means that your daily life will our smartphone one day you know us better than we know ourselves these mainstream technological transformations left me wondering how this will impact the dental profession in the last couple of years I developed strategic partnerships with the University of Toronto where I once served as a research director and the community Dental Health Services Research Unit and I studied population data and back then it was all about spss and statistics but times are changing and if anyone worked with these software programs you'll be keen to say that we did big data before big data was big data we've also partnered with Stanford University and have developed aggregate data to help understand what is happening in our profession through numbers the University of Toronto recently got a hundred million dollars as a donation from Heather Iseman and Gerald Schwartz who are friends of mine for funding an AI Institute the work of the creative destructive labs which sounds pretty interesting but the work that they've been doing has been transformative in developing companies in AI a think tank if you wish so how do we navigate the changing times of data data ISM algorithms in pivot to the new world of official intelligence the carbon age of life has been around for millions of years and we Homo sapiens emerged 200,000 years ago but silicon chips have only been around for 50 years and their exponential rise leads me to believe that artificial intelligence is just around the corner and i've seen it firsthand on the campuses of Stanford and Silicon Valley and in my alma mater the University of Toronto and how has Dentistry prepared to evolve in this capitalistic society that is built on evolve or perish will humanoids as seen in shows like West world be the the front desk staff of tomorrow well IOT the Internet of Things transform the dental chair where we'll be able to know from our iphones for example when a chair was last sterilized or when the lines were last run or how long a patient has been sitting in a dental chair for treatment or how long it takes for a dentist to cut a crown is we all have stories what how long it takes us to cut a crown right information is going to be where we need it when we want it in patients are going to start to demand this information this transparency and those times are upon us my firm dental erica has been working on just these questions we are building the first dental databank as a nonprofit organization to house patient data in an autumn eyes aggregate form to create the largest data bank in the world is our hope we are pursuing this with Stanford University in Silicon Valley in a collaboration with Microsoft dentistry is the ideal model for understanding how to monetize data in the healthcare platform why because we have low mortality and morbidity which makes it very predictable so when you create a model that is the ideal we want to use this data bank to improve quality of care and equally as important consistent here but how that is the big question how when it comes to data I believe data will do what currency are you paper money did to gold and silver coins once upon a time I believe the political agenda of monetary policy is out of check and it is driven by motives that unfortunately are not aligned with society's interests data is becoming our new currency we all say information is power now we can say this literally currency has to buy information one they will skip that process we don't need to buy the information because the data is in of itself the information look at Google looked at Facebook looked at Apple why are they acquiring so much data it is the future it is the future banks of the world when machine is asked to visualize things like for example how many people are sitting in this front row it has a very difficult time if you don't believe me ask the Lexx ask Siri to do that it can't but if I was to ask a lexer Siri to calculate three thousand five hundred fifty two times four hundred and forty two the answer is just like that and so how do we negotiate silicone machines and carbon beings like us that have different abilities and how do we negotiate living in a material world together when we process things so differently Madonna in the eighties wrote the song Material Girl I'm sure we all know that song I hear she's coming out with a song digital girl well I don't think she is but maybe she is but I can't confirm it but that's our new reality denill Anika started this journey in Palo Alto where silicon began and where data is amalga rhythms had the most profound impact in the rise of Google here we learned that data and health are the future Stanford is so invested that they recently Cree an AI for Health Institute to foster this understanding better we are in the process of developing a flagship project with Stanford so imagine this you press one button and your radiographs are reviewed and the diagnosis is formulated with 100% accuracy imagine how the access to the best radiologist in the world with one click and those radiographs have the algorithms of that radiologist imprinted in the technology imagine patients can access their records from their phone imagine knowing carries risk profile when you first meet a patient because it's on their phone and they being their information to you imagine insurance policies that are democratized and risk is more evenly distributed across the population because individualized data permit us imagine a building imagine building a system where we are paid to maintain health as opposed to always just treating disease this my dear colleagues and friends is a world I dream of a world I am working on in building with my team at dental Etica a world where more people can smile because we know how to gain insight into our oral health walk through the data systems we are building through the democratization of dental data leading minds can build systems that are built to reward kids and adults alike for being active participants in their oral health how us that technology exists today like IOT toothbrushes is anyone here have an oral-b toothbrush or a Philips toothbrush that keeps track of how you brush and how often and the time and every Ward's you so imagine now that you get rewarded with loyalty four points for that imagine when you go to your dentist and you leave and you don't have a cavity you get loyalty points for that now we get loyalty points when we buy fast food leaders in society and as guardians of our great profession need to create an environment of oral health promotion and rewards to incentivize positive behavior we need to devote more energy in developing a health system and not a disease reactionary system an ounce of prevention an ounce of prevention is worth a pound of cure we need to be paid to maintain health and promote health not just deal with the ill effects we now have the technology to do just that data is amiss giving us insights 365 days a year 24 hours a day let's harness the power of data ISM and build a world where barriers access to care are eliminated and quality of care knows no malice together we can build such a world thank you.