Trish Walraven is a dental hygienist, blogger, and software designer. After graduating Magna Cum Laude from Texas Woman’s University, she spent almost 25 years practicing full-time clinical hygiene, including 5 years in the private practice of the Dallas County chief forensic odontologist, and 17 years in the office of Dr. David Rossen of The Colony, Texas, which was featured in a Dental Town office visit a few years ago. In 2008, Trish founded DentalBuzz, a dental trends website and blog, and in 2014, she and fellow Townie hygienist Erika Feltham collaborated on a DentalBuzz article about the blue specks that dentists and hygienists were seeing under patients’ gumlines during recare visits. The news that these plastic microbeads were being added to toothpaste merely for color gained national attention, with their awareness campaign culminating the signing of a bipartisan bill by President Obama in December of 2015 to ban the sale and distribution of products containing microbeads in the United States.
VIDEO - DUwHF #1258 - Trish Walraven
AUDIO - DUwHF #1258 - Trish Walraven
Trish continues to write for DentalBuzz and is currently spending her time with BlueNote Software LLC, a medical intra-office communication company that works with dentists, optometrists, veterinary hospitals, and other medical specialties to help offices manage the workflow of their offices with virtual light panel systems.
Howard: it's just a huge honor for me today to be podcast interviewing Trish Walraven: are DHBs she's a dental hygienist blogger and software designer after graduating magna lot from Texas Woman's University she spent almost 25 years practicing full-time clinical hygiene including five years in the private practice of the Dallas County chief forensic odontologists and 17 years in the office of dr. David Rosen of the colony Texas who we just had on the show a few months ago which was featured in a dental town off visit a few years ago in 2008 Trish founded dental buzz a dental trends website in blog and in 2014 she and fellow townie hygienists Erica Feltham collaborated on a dental buzz article about the blue specks that dentists and hygienists were seeing under patients gum lines during reeker visits the news that these plastic microbeads were being added to toothpaste merely for color gained national attention with their awareness campaign culminating the signing of a bipartisan bill by President Obama in December of 2015 to ban the sell and production of products containing microbeads in the United States Trish continues to write for dental buzz and is currently spending her time with Blue Notes software LLC a medical interest communication company that works with dentists optometrists veterinary hospitals and other medical specialties to help offices manage the workflow of their offices with virtual flight panel systems my gosh um actually the first I ever heard of that story was when you posted it on dental town I I think I think you might have broke that story on dental town
Trish Walraven: well actually that's where Eric and I met at one another she was the one who had posted some findings herself and I looked at that she did some research sleuthing just a little pretty little science hat on and said what is this and she's the one that actually uncovered the fact that the plastic was there and the two of us collaborated together since I already had a platform of just awareness kind of campaigns we the two of us created a story to get out to the public that there was something that hygienists were seeing and once it hit the hygiene networks and all of the social media that's really when it caught fire because I believe it every hygienist in the United States at the same time realized that's what those blue dots that I'm seeing are and so we literally connected the dots on dental town and on hygiene town and at that point was when they started sending in emails and phone calls to Procter & Gamble to say hey this is not acceptable to us so that's really how all of that kind of rolled it was it was a effort really on a lot of fronts different social media hygiene groups out there is what kind of spread that it just went viral for the most part so looking back are you glad that you did this and
Howard: are you glad the beads are gone I mean what was your what's your summary looking back now hindsight being 20/20 and we're almost we should all be seeing very clear in three years in three months because in three months its 2020 yeah that's and
Trish Walraven: we don't we keep hearing that all the time you know 20/20 is is the year of the eye care practice right you know but the as far as the beads themselves absolutely I think all of us are relieved of the fact that there was enough of a push from grassroots efforts to say this is not necessary in our products there there was the potential for causing harm because there was an embedding that was happening of these beads we were finding them down in deep I paired all pockets just you know regular sulking also just and the fact that there's one less thing that is being in our mouths contaminating I guess is probably a good word to put that the better so the fact that all of the microbeads have been banned in the United States from all products is good for our environment number one they've basically qualified alternatives now natural products like walnut shells and and so forth that are used for the abrasiveness so yes it's a good thing
Howard: do you think that seems like the history of toothpaste as that they all came from the soap companies like Procter & Gamble when all these companies realize they were already making soap and all these soap products and they just had to add fluoride to one and and make a toothpaste I mean is that kind of your historical origin belief of toothpaste I mean is this isn't this where it really all started was just soap surfactants head fluoride Taylor a product for the mouth
Trish Walraven: well yeah I mean the fluoride was definitely like an afterthought the essentially as far as what I know I mean just the fact that Procter & Gamble is a detergent company it's no surprise that they make toothpaste because toothpastes base ingredients are soap and that is they had to find a way to make it a therapeutic benefit versus just a daily clean you know so it really isolates it from Ivory soap I mean this is not ivory soap now it has a health benefit and that has really evolved into almost like a health industry in and of itself it's like consumers now listen to what the toothpaste ads tell them about all the health benefits of toothpaste is like and if you use this toothpaste it's almost like the undercurrent of what they're being told is then you don't need to visit the dentist anymore
Howard: but you know I'm true so hair used to always tell me that him dry brushing is um there's no really even need for toothpaste I mean to remove plaque and she was a she was a big dry brush around you and now it seems like most patients the way they talk to you it's like one of these which one of these toothpastes is the secret ingredient and I always say you know use whichever one that you'll use twice a day yeah and like for me some of those two pastes are very nauseating I have five sisters and a brother so that's a pretty big genetic sample and me and my sister Caitlin we gag when we brush early and for me close up that red you know toothpaste where for some reason cinnamon yeah for some reason that one and the same with her we both like that too then I say you know what you don't even need toothpaste dry brushing is fine as long as you do it for two minutes just use the kind that makes that you like right do you have any favorites when it comes to toothpaste
Trish Walraven: I like bathing soda I actually like the taste of baking soda I like the texture of the baking soda yes I have been known to do that if you use pro feet jet powder it's baking soda that's what I used to spray that on my toothbrush a little bit and actually brush with that at work but yeah that's that's my favorite flavor of clean but it really does and I like anything that tastes like a vanilla tic-tac it's like the vanilla mint I think that's one oh wait but you're right it is about flavor and acceptance of accepting a flavor that you will consistently use you don't want to use something that's going to gag you out you know when you personaiiy it's funny that you do you like the close-up that cinnamon flavor that's like the worst flavor too many fireballs
Howard: okay remind you of your fireball days taking shots of fireball yeah so um do you is that BC I mean I mean a lot of people push around on the toothbrush toothpaste abrasive chart and they have the you know the very low abrasive the low the medium abrasive the high abrasive and do you is that what are your guidelines on recommending or not recommending toothpaste
Trish Walraven: no not believe it or not that the abrasive it each chart is I mean I'm aware of it but as far as telling people which to use or which not to I would say sticking to the major labels most of them have and I know that pronamel is probably one of the least abrasive toothpastes out there so and it is one of the big toothpaste leaders so you you're less likely to find a high abrasive toothpaste with the standard ones and probably the white whitening has a lot to do with not necessarily the ingredients but the particle size so the scylla the hydrated silica that's in toothpaste will be adjusted size-wise and even the shape of the particles if the particles are round they're less likely to be abrasive versus if they've been manufactured with lots of sharp edges that will increase their abrasive 'ti so that's that's what that's all I really know as far as toothpaste manufacturing I
Howard: this weekend the news was being dominated as far as um dentistry mouthwash use could inhibit benefits of exercise did you see that one going around where mouthwash use could inhibit benefits exercise sciences have shown that the blood pressure lowering effective exercise is significantly reduced from people rinse their mouth with antibacterial mouthwash rather than water showing the importance of oral bacteria because you know when you're an athlete they always teach you to breathe through your nose because when you breathe through your nose picks up nitric oxide which dilates your lungs and mouth breathing you know you have to breathe so much more but that when you're using mouthwash it kills a lot of these nitric oxide producing bacteria and it negates the benefit of cardiovascular that just rinsing with mouthwash negates that benefit I thought that was talked about just more food for the oral health continuum of how the mouth and the body and everything's just all related into one mechanism I thought that was very interesting because out of here in Phoenix I see so many people when they're training for Ironman put the the duct tape the big is it duct tape the big silver or
Trish Walraven: yes that's duct tape they just wear those masks I people were the training masks - right - basically continue that nitric build-up the nitric oxide buildup so that they're training in a level bits I think that has more to do with just oxygen depletion than it has with anything because there we do they're reducing their oxygenation so when they don't have the mask on where they're actually in the marathon or what-have-you it's like being on the surface of you know it's being it's like it one at sea level versus you know twenty thousand feet as far as you know the oxygenation that their bodies are accustomed to
Howard: yeah III thought that was very interesting you had a study and I read it and I read the study and I actually emailed the author and it's it's really a serious thing so talk about dental buzz when when did you start dental buzz calm and tell us what was going on in your journey when you started that
Trish Walraven: well actually it was essentially a I had a lot of opinions and it was a matter of goes out there and saying you know what I want to start playing with words I want to play with the ideas that Dentist have that maybe not in such a serious vein everything that we read on the internet it seems like is all you know gloom and doom and seriousness and it really just started as a kind of a humor place just to have fun and and make fun of dentistry a little bit that's not gonna where it's evolved though we still try to keep a bit of fun in there and and keep it light in other words we're not going to handle like really serious life-and-death topics but it has become more consumer centric like this is accessible not only to dental professionals and making fun of ourselves but also we want you to cut we want consumers to come into our world a little bit it's like kind of see what we are like on on our more playful days essentially and that's really where gentle bus kind of started but it has it has skewed in places that I did not expect it to go it's been a fun ride I
Howard: I've always enjoyed it I'm your last one was white dental insurance makes good people do bad things what was your well your and I love your how insurance work you talk about fire and property you talk about death and life I've never understood how people believe in in a dental insurance I can't believe they buy their own house they buy their own car but they think they're incapable of buying a major purchase like lately you got lung cancer yeah or say you had to have a hip or knee is the catastrophic stuff everything you get catastrophic is still less than the price of your house and and you take so much more interest in buying your house and your car but it seems like like like dental dental is only 5% of the budget I have people that live next door to me in million-dollar homes and they come in to me and I'll say they'll say but but but I don't have insurance and you're like well marry you you live in a three million dollar home in five cars I mean I mean it's such a bizarre but where were you going with when you wrote white dental insurance makes good people do bad things
Trish Walraven: okay so where I was going with that is not necessarily saying that the person working in the dental office although it could apply to the person working in the dental office but it actually makes consumers do bad things and that was really my ploy there it's like you are not as a consumer aware of the fact that that your dental insurance is no more than a excuse for you to only go to certain doctors if you're in a PPO or and not and tell yourself well I can't afford the good dentist in town and so this is that was a way to open that up to everybody and make them realize you are a valuable person and you need to go to the best in us in town and not just the one that takes your insurance and just divorcing having people divorce their beliefs from their insurance company and saying you know what you only have this much amount of towards dentistry anyway and if you are paying for out of pocket you're your Delta is really only about twenty percent if you were just doing that yourself versus you know expecting on somebody else and you're more likely to get quality care that lasts longer versus being forced into like an HMO type of plan where they have the only money that they make are the add-ons you know they get a stipend per month when you go to an an HMO dental clinic and then anything above and beyond they have to Bill you for that and people are like it's just shocking when they realize that money I could actually go choose the dentist and just pass that out and we didn't even have to play the game of you know what umbrella am i under
Howard: yeah and what's amazing is is people I just love the examples where you use property insurance use fire insurance and and how co-payments are everything and when you look at a health care the the fact that Medicare or Medicaid there's no co-payment people will go get a $50,000 knee replacement they don't even know the cost but if they if they just had a 5% co-payment that's the first time they'd see that it cost fifty thousand and then they get on the internet and they find out well it's fifty thousand in Phoenix if I drove it to Flagstaff it's only forty thousand and I'm gonna go visit my sister in Utah because over there it's four and all save all this money yet when you tell someone that every single person on Medicaid Medicare insurance should have a co-payment they look at you like you hate poor people and it's like we have a hundred years 200 years of hardcore science and economics and it's just bizarre how some little thing like insurance and people just throw all their common sense out we know now they're a victim now now you can a million dollar home but you can't fix your tooth because you don't have insurance and it's just I mean it's just just it just blows my mind how bizarre is what you also work for Blue Note software you're a consultant for Blue Note software I'm tell us about your journey what were you doing your life when I know they're closer they're in Keller Texas is that did you know them from just living in Texas together or how did your how did your journey end you up at
Trish Walraven: Blue Note software how we ended up with Blue Note yes so essentially Blue Note I've kind of been along on the on the sidelines with Blue Note for for years and years because volved in 2003 believe it or not is when the company was established and it was a telecom company for for dentists to have phone systems custom built and installed in in their practices so it's primarily communications and then guess about 2000 probably about a year later was when they were doing the the the Blue Note people they weren't even Blue Note at the time or a different company they were sitting down and doing a napkin sketch because they're trying to figure out a better way for dental offices to communicate the real times they didn't want to put phones in the operatories they're like we need something else to communicate with and this doctor is hard against doing radios we're not going to put any but thing in anybody's ears and we're not gonna put the things on the walls what can you do for us how can you build something and so the engineers were able to just kind of mock up a few ideas they sent it out to the Southwest Dental conference the next year had about 50 dentists sign up for it it didn't even exist yet at that point and that's really what got the ball rolling with it is essentially a virtual light panel system that also lets you use your cell phones to or and your smartwatches to no real time communications so that anybody in the office can be have their their office communication the real-time communication transformed into tasks that are visible and audible and essentially that's it's been growing since 2004 and so here we are now I join them in 2016 and and is I'm doing some consulting I do some trainings with them and my husband is one of the original developers so that's how I tie into it
Howard: Oh your husband developer or programmer
Trish Walraven: yes he does he does the behind the scenes things for for Blue Note and so that's and then so that like I said I joined him about three years ago so how many so is it only dental no its dental veterinary eye care general medical offices primary care a lot of primary care clinics use Blue Notes essentially instead of the buzzer system on the walls for letting them know hey you know what we need a lab draw in this room will press a button we need that we need a handoff to an optician we need a handoff to a front desk person you know for case presentation all of those kinds of things are basically tasks on a like a virtual whiteboard or a dashboard and everybody is able to then look at that in no matter where they are in the office or who they are and collaborate together and go okay I'm free you're not I will go do that for you and everybody can make a decision at that point who takes care of that task and then they clear the tasks so that everybody else in the office knows that's no longer needed but it looks it just looks like a light panel you know a little buzzer thing on the wall but it's virtual it's it's computerized is dentistry the biggest part of I mean it's dentistry you know general dentistry ortho oral surgery para pedo is that bigger than say eye optometry veterinary others I mean our dentistry your yeah it's still our home base so I would say at least 50% of our sales are still dentists and then the other 50% are the other and are the other industries out there but what we found that yeah everybody has this need and and they don't necessarily they get tired of their radios they get tired of having to me manage all of that and having a network based software system versus cloud-based also is what keeps it hip as secure so you're not having to worry about did that get out on the internet did I have a breach you know everything stays local on on their own system so they can and Howard: what is the pricing on this it's its lifetime licensing
Trish Walraven: it's less than a thousand dollars and that's a one-time licensing you buy it one time for a thousand bucks and that's it doesn't need any maintain main maintenance essentially you just install the software on all the computers where people are communicating and just let them run with it because it's very intuitive they just figure out oh this is this says you know Sally to op3 and they just press the button that says Sally to op3 and Sally comes to op3 if they program it that way everything is contextual so you add the help help them add the context or they figure it out offices are able to usually build this on their own
Howard: so I'm well that's the hardest business model because once you sell something for 995 your business starts to scratch again you have to sell another one to go that's why Netflix had a valuation as high as Disney because Disney you know they did invest 100 million into a movie that go do 300 million at the box office they meta you know it was boom bust boom bust but never like no we're just gonna get 10 bucks a month from everybody so you have that guaranteed income and and right if if you don't have that if the Wall Street would rather you sign them up for ten dollars a month for you know ten years agreed they can get all the money upfront so why why do you stick to a feast famine business model and instead of just taking their credit card in saying on the first a month of every month we're gonna ding it for you know 10 bucks 15 bucks whatever you know why why do you do that you got to give me a grand and then you're back to square one the minute you ding them for a grand what do you mean back to square one you won't you mean that so that's right because once you made that sell you you have no more revenue coming in for the whole future yeah not from them
Trish Walraven: we don't need their we don't need their business anymore so my question to you is which model do you prefer as a consumer
Howard: well I mean I would rather buy it once and never deal with it again you know that's me but
Trish Walraven: why we do is because we understand our consumers and because this is a market that is a very niche market there's not you know not every medical practice once to do it this way not every eye care practice not every dental practice wants to do it this way it is sustainable because of word-of-mouth as soon as one office puts it in one practice they may have 30 practices they may put it in all 30 of them and that way it helps sustain our growth that way and we're able to grow by word of mouth and and Google searches of course so we've
Howard: we stopped using our walkie-talkies and that we loved them for a long time are you or
Trish Walraven: is this replacing a lot of walkie-talkies yes we hear a lot of people saying I'm taking my plugs out you know that look the role with blue note for about a week and they're like okay time for the plugs everybody's taking them out and they're very happy and they don't it nobody looks back and they're like this is doing the job that we need it to do okay so be real specific what's the difference between an office listening to you right now on the walkie-talkie system versus the blue note software system okay it's really easy one person in the office basically guides all of the the tasks and they just set it up the software and they're just they're ready to use in other words they've created the protocol with radios you have to sit down with everybody and say okay when you do this I need you to do this and when you do this I need you to do that and everybody has to understand that protocol in other words it's in here it's all stored in here versus in the computer the computer will store the workflow for you and it's already pre established and then everybody just looks at it goes oh I need this and they just touch it touch a button and all of it is just intuitively there so that's probably the biggest difference like
Howard: so for a 900 I called 911 the person answering it would be like my front desk they're there they're answering 911 call but it's actually the dispatcher who decides who's gonna respond to that call am I gonna send to the fire department please no so so the receptionist answering the phone would be like the 911 operator but the dispatcher is the one running the blue notes to the side who's gonna do what the Blue Note software you said it's
Trish Walraven: one person sets the system up once it's ready to go it's a one-to-one or one-to-many as far as communications in other words one person just has to get in their computer and know how to do the configuration in order to create the context for that particular office they didn't have to tell everybody how to use it it's just and then what they do is they set up the software and then once it's available for use the doctor can basically use it to call for an assistant the hygienists can use it all for probing front-desk can use it to say hey here's the doorbell sound for you know hygiene three your next patient is here and hygiene 3 will have a different doorbell then maybe hygienists too so those those are what I'm talking about as far as one person sets up all of the sounds and all of the lights to make it unified for it throughout the office
Howard: very interesting there's a thread on this going on right now on dental town it's interoffice messenger have question for IT software gurus I'm looking for an interoffice messenger app and it seems like this is uh it seems like the trend is going away from the walkie talkie days back when Motorola I'm a I always wanted you know I'm in Phoenix Arizona that's where Motorola was huge I knew that and I didn't know if that was what wait why do you think the walkie-talkie is being replaced I mean like I say I we stopped using them in office wait what do you think walkie talkies are being replaced by other means including your husband's company Blue Note software Blue Notes software by the way where does that come from Blue Note software what's the story behind that
Trish Walraven: well the first iteration of the software were actually blue notes they were blue and they were notes and they popped up on the screen and they were always blue so we're like let's just call it blue notes and there's still a lot of that blue element in the software so but the reason why I I really don't know why people aren't you know not using their radios as much they just say they're tired of the chatter the front desk will say you know what I'm trying to talk to the person in front of me I don't want that to also have to be listening in on a conversation in my ear same thing for back office they don't want patients to listen in on the little quick chirps that they're having to tell people that's probably the the biggest thing that I see but you know we don't hear from the offices where the radios are successful so there are a lot of offices that are enjoying the benefits of radios don't get me wrong I really think they are the the most intuitive way because you don't have to go and buy any software everybody knows how to use their mouths everybody knows how to use their brain right so there's their radios are definitely you know there's a way you guys give up the radios that would be my question um
Howard: well I only go back to the why I went digital to begin with and got rid of paper charts it's because I had a protocol that you know because I knew like like dentists would use an electric surge because I an associates that would use them yeah I mean yeah and they would and they didn't like the tissue around there so yeah I feel like shirt and packed cord and everything and you would hear them tell their dental friends they have no post-operative discomfort but you would hear those patients calling in begging for pain meds and vicodin and refills and all the senses so I I made this protocol that that if someone called you had to enter the note in the chart well they they were they wouldn't do that first they couldn't reach it so I got him longer deals and I got him cordless phones and I got him headsets but I couldn't get them to keep pulling paper chart so it was 1989 when I realized okay well you know what you got to do now just get rid of the damn chart if you get rid of the damn chart you'll solve this problem so I got rid of all the charts so now you call up I have to pull up your chart right and then you know so I internet and and when I go in through the office um the other thing is when I would ask for something and they'd have to leave the room I would I would leave the room too and I'd go to the office manager and say okay I'm doing a root canal this is like the thousandth time I've done a root canal and when I asked for this thing that I always asked for every time I do a root canal which I've done a thousand thousand thousand times why does she have to leave the room I mean would you like to be in the middle of the surgery you're in the middle of brain surgery and they asked for give me the the standard instrument oh I got to leave the room I gotta go so so so I would set a protocol rule that when I sat down to do surgery because everything in dentistry is done hands-on we work of their hands it's all surgery on a live patient you're not leaving the room and if you're leaving the room I'm leaving the room because I'm gonna go get your boss and let her know that somebody you know there's some failure of communication but when you keep setting the bar high eventually you you don't need it and I think that um I think that we got so digital and then I also think with them using the Oh what's the saliva suction light thing in your mouth isolate your old I'm just retracting and suctioning which didn't do it for me because when you're older you need a lot more light and you know so that that thing it just lights up the stage it's better I think they just they just really didn't need anymore I mean the assistants had free hands they weren't with the isolate they they could you know use her computer they could use email they could use other things but I like that what I like most about the walkie talkie so I could always hear what they were saying in your ear and you never thought I could hear so I always thought it was great you know because I could I can hear them talking about me on the deal you know don't send him in there because he'll he'll do this so for me it was a great form of communication just to know what all my staff would say you figure out things like if anything is seating any paint we only have a table so if they seated anything in room nine I always know was food so then I knew to get the hell out of that room quick and get back to her to the break room before someone else ate all the good food haha but but yeah they my staff they they voted it down one day and it was dead but I mean it but it was a big part of our practice for 20 years so what do you guys using now god you know I don't even know I think I think there you just say go here and I think I think there I mean it's something on the computer okay so and
Trish Walraven: that's really what a lot of things are evolving to a lot of people are using the unsecure messaging that there are cloud-based those are there's not really any of them that you're not going to pay more than about Oh $50 $60 a month for that aren't HIPAA compliant so do keep that in mind things like anything cloud-based I don't even like Skype is not HIPAA compliant even though they're not using it for patient data the fact of is the the big concern with HIPAA Security is not whether or not you're using it it's that is it a vector is it a potential vector and key will Skype back you up if you ever get audited they won't they won't say this was not the source of the breach and at that point you've shown a vulnerability you can get a slap with fines so definitely anything cloud-based you want to be cautious make sure that it is something that you are paying for and that they've assigned to be a a with you but that's what's right nice that's another reason why the price point of something that's locally hosted is a one-time fee is because there's not any maintenance needed because it is staying you know on your network and it is not letting anybody be able to know when there's cookies in the break room right
Howard: well I was I was very sad when I'm Microsoft bought LinkedIn and Skype because I mean I mean it's one of the lowest quality companies I know everybody loves Bill Gates the richest guy and everything but I mean I mean I grew up with Bill Gates and every time he released his software let's say you bought it for $300 you'd have to pay someone $900 to come out here and fix all the bugs the patches and and every programmer I have as a patient says they they they know they release crappy software riddled with bugs and then you had Steve Jobs over there with iPhone that would dot every I cross every T and just release perfect software then you had Bill Gates over there just I mean he made a used Chrysler look like a Mercedes Benz and when and the minute he bought LinkedIn I said okay well now LinkedIn will be garbage and he bought Skype so yeah so I mean I mean I know I mean it's embarrassing when the richest people in your country cared nothing about quality and they you know they just money' moneymoneymoney sell sell sells be a billionaire whereas jobs actually said no I want this thing to look nice I wanted not to have bugs I want to run great I mean I mean job jobs pretty much made a mercedes-benz iPhone mm-hmm and then Microsoft a 1964 Dodge Dart what will make software so bad you wish you had a Dodge Dart from 1960 so yeah it didn't surprise me LinkedIn Skyped in everything
Trish Walraven: you bring up Steve Jobs tonight I think my thought process on him is I try to imagine what he would think of if he were to go into any one of America's waiting rooms these days and look around and see everybody looking on their mobile devices that his company pioneered what would he think about that culture of everybody staring at their phones no you have to be cautious of how you're building society sometimes and not real and realize that maybe you it is mostly for good but there's just so much instances I'm hearing of you know just anxiety that's being caused by the you know divide this like I don't have my device and I and I'm guilty of it from time to time myself so I do understand that you know sometimes the just not having money being the object is not always enough
Howard: yeah but I I read a whole bunch on that um that open loop deal where you know I think after jobs a lot of people figure out that physical like video on TV like um you know there'd be really interesting scene at the movie but then they break for commercials so they would leave it open so you'd have to stay through the commercial to see how it closed mm-hmm stay tuned when we come back we'll tell you did she really you know what did she do so that open loop method and then and so I think they have so they understood the addictiveness levers on it but they manipulated him a hundred percent like for instance you're a social animal and you have a media so when somebody deems you like they always say on all these apps they want to be able to notify you of a message because they know if they send you any type of the signal that's from another Homo Sapien and you're a social animal you you're you have to see what what's that's about well they know that's addicted they know you're driving to work and you hear that ding and you're checking it as you plow into the car in front you mean so so so much that stuff is is intentional but I went but last weekend there was a big story where hundreds of dental offices were hacked into across the nation and hit with ransomware and I was wondering out what you thought of all that
Trish Walraven: well yeah I followed it just on the sidelines essentially it looked like it was again you don't know necessarily where the the threats can be they can come from anywhere and essentially if you don't patch all of the vulnerabilities because you could have you know piece a of your software piece B if your software piece three secure but if you've got one little piece and you can and the hacker can thread through all three of those like safeguards they've gotta weigh in and it's I don't know the specifics of how that virus or the ransomware got on - everybody's machines but it was fortunately it was resolved very quickly the little ecosystem of hey we will bring in our experts that have they can get this code from the hacker just fine there's there's this third party as far as what I would I know a whole ecosystem of negotiators that go in between like the person trying to resolve the ransomware and the hackers themselves and they're they're getting little cuts of all of this system - so you want to talk about dark web ecosystems that's one that's I would never ever want to be part of well
Howard: you know what it made me wonder okay so this the digital dental record is a wholly owned subsidiary the Wisconsin Dental Association and so basically yeah I feel sorry for my homies there you know you hit about 400 officers they're pretty much all in Wisconsin they're thinking well I got a non-profit Wisconsin Dental Association I pay my dues they're looking out for me this is their own wholly owned subsidiary the digital don't render they do everything right and then they end up having everything go wrong and it me and the first thing I thought was I was talking to a guy here who's with the man that that's that's not a service I would get into I mean I mean you're not talking about some little kid in the basement hacking in when he's between fortnight and you know and whatever video game he's on I mean these are I mean China China said I was a long time ago they they announced they had over 100,000 people in their AI military hacking you know the North Koreans the Russians I mean these you're not playing with amateurs on this stuff I mean I I just I just don't think I mean like on dental town I mean ever since we started dental town I have adamantly said there's been a bunch of reasons why we should take your credit card story your credit card you know do all these things for and I'm like no but you know I don't want to have I I don't want to have a whole bunch of dentist credit cards on my computer because guess what happens somebody's gonna get in there and then all the dentists are going to say Howard and they stole my credit card from your site so would you would you and your husband and and Blue Notes Blue Note software advise dental societies that this business is kind of added their league
Trish Walraven: the business of managing your own your own security out of your the up and cloud a cloud stores it is surprising how how many offices do their own IT and whenever we hear that I would definitely I through III I just it's a Hail Mary to hope that nothing is going to be there that's causing damage to them I feel more for them than anything but yes you I would say having IT professionals managing all of that for you making sure that the remote access software is secure because I think that's really what the hack was that was the vulnerability was the remote access on those dental offices so just make sure all of all of the bases are covered and that they have secured any any places that you could get targeted so and I'm not an IT person again I'm a hygienist that kind of got into working and we're working on the computer side just by proxy but it's been enjoyable it's been really neat seeing how offices just their cultures and getting to to help them expand their culture and say hey look this is how we do things in our office this is why we do things this is what's important in our office and basically making being a glue in their office so that they can all express themselves to one another so that they get their jobs done and they all get to go home at the same time every day you know and not run behind because they've had miscommunication you
Howard: you were posting on the other day on bonus systems for hygienists and you said that you preferred the BAM bonuses to departments but what do you what do you think about um hygiene I can't I mean immediately managed people time and money and incentives work that we started this podcast with the insurance setting if a person doesn't have a fight a co-payment they have no skin in the game so don't care about the price the cost craziness when countries bragged that oh I had a I had a hysterectomy and I didn't even have a bill okay well you know the system is completely broken because the patient the most important part of this whole system doesn't even know they didn't even look at their numbers you show me a dental office or a restaurant he doesn't know their numbers it's completely broken and having any system where it encourages people not to see the numbers well you're not by your system you're bragging about how broken isn't it but you've been on us for many moons and many nights what do you think of bonus systems and specifically towards hygiene department
Trish Walraven: so we played with a couple bonus systems and you know we've done the grab bags different offices did different things but I think everybody in our office we did the the BAM bonus where it was a group effort and I spent essentially everybody maxed out their licensing so you think hygienists you know they we we are licensed to scale teeth and you know the Dentist could scale teeth too but we would never asked a dentist to do that so anything that's not scaling teeth you delegate that to somebody else in the office and that's how you essentially increase your efficiency I'm a big advocate did accelerated with accelerated hygiene I did it for many many years found it to be very rewarding because I could see patients not worried about necessarily the clock but not worrying about okay how long is the doctor going to take so that I can get my room turned over I never had to turn over rooms I never had to clean you know instruments or even go seat my patients or dismiss them none of that is a factor when you're accelerating your schedule and letting hygiene assistance essentially carry the that part of the load for you but that's when everybody in the office deserves to be part of a bonus system I don't think that hygienists should be you know singled out because we're producers per se everybody in the office is a producer and they have a value to getting a patient to say yes to treatment to getting same day dentistry done to getting all of the things that are going to keep that office in business and thriving and helping to serve more people so anything that it takes in order to you know increase those those so I guess BAM bonus is you you set a threshold so let's say $100,000 is your goal for the for the for the month and so if you get under that threshold as far as your production you know your adjusted production is concerned you there's no bonus but anything above that the whole office gets to join in a percentage of $15,000 the office gets to split that 15,000 bonus you know however way that the owners seem fit
Howard: and who is the author of the BAM bonus BAM Bing BAM base amount to meet who you say is the on the the the I don't know who the author is to you is it Denise Sierra del oh you know her
Trish Walraven: I don't know we we worked through a quantum leap is the practice management they did introduced us to that it's been many years ago I couldn't tell you all the details and the people involved but there were the ones who introduced us to that that type of bonusing system and it was it was very enlightening when we did it we didn't do it for very long everybody in our office was salaried and we were happy with our salaries so even though I'm you know preaching the BAM bonus I think that it really it can get you over humps and hurdles and I think that's what we needed during that time of art we had some growth that we needed to do and that helped it's
Howard: uh yeah I got um I think that's the nice Sara dela who's out near you she's from Texas on geez okay GTS gurus remember her GTS gurus and I don't global team solutions practice management but what's funny about that is that you like that but my gosh most of all my homies listening to you right now if they went back home and saying thought they were going to tell their hygienist that they were gonna do what do you call it expanded accelerated hygiene mm-hmm they would even go to work tomorrow they'd be so afraid to go to work to face their staff and yet you liked it why do you why do you think it's so to me it makes sense I mean as a dentist I don't want to go out there and seat the patient I don't want to set up the room I don't want to do all this I want to go in there in fact I'm such a brat that if I walk in the room and they're not leaning back and the deals on I say um they're not leaning back in the lights on looking I'm like you know are you not ready do you want me to come back or I'll go do I use like I mean I I don't want to go into every room and the first thing I do the rest of my life is lean the chair I want to walk in there and ready to jumping jack flash I don't know why I would go to four years of Hygiene to set up the room go get the patient seat the patient III wouldn't want to do anything that the dental assistant could do mm-hmm and
Trish Walraven: I see I definitely see it that way that you know all of those things are they take away from your mental I don't know stretch it just it's one more thing to do you have I can't step 1 step 2 step 3 step 4 step 5 what if you only have to do two step 2 step 3 and step 4 it's like just that the mental processes involved and then and the certainty of knowing exactly at 3:30 I'm gonna go see this patient and I can chat them up for 30 minutes I can clean their teeth I can ask about their home care I don't have to do anything else their x-rays are ready up on the screen the doctors already looked at the x-rays they've already have suggested pas all of that happened before I even came to the into the operatory to you know provide my preventive services and III don't understand I do understand the fact that you know the thought of seeing you know 12 patients a day 13 14 15 patients a day up to 20 patients a day can it's exhausting to think about it but on the same hand you're seeing more people you're making difference in people more people's lives when you're doing that and you're still in the our office the same eight hours that didn't change you're still there you're just maximizing your abilities
Howard: so how many how many years of it is that I was a high jet that I was did accelerator hygiene
Trish Walraven: 2003 from ten to twenty sixteen so quite a few years and
Howard: how do you see how do you see the dental market going now that you've been in I mean you're in Dallas you're seeing DSOs come and go you're seeing a lot of changes in the market how does this um how do you see this how do I see the acceleration of gold just how hi James I was the the DSO and corporate dentistry changing hygiene
Trish Walraven: a lot of the DSOs don't even hire hygienists or I shouldn't say a lot there are a few they essentially let the doctors hire / hire doctors make the doctors work really really hard and then have assistants doing the final polish I find that they're the ones that are hiring the hygienists I can't speak from any expense because I've never worked with a DSO but it does seem like that they seem to be very numbers oriented and trying to exaggerate periodontal needs so that would be one reason that would be the big red flag for me it's like as long as they're the paradol needs are not being exaggerated in a DSO a hygienist doesn't really the time requirements that they're asking these hygienists to work on are I think very you can choose that if that's if that makes sense to you I don't see any ethical reason not to work for a DSO as long as they're not having you falsify treatment doing excessive care
Howard: well the bottom line is there's only three dsos that are publicly-traded and three four three of that publicly-traded do not have hygienist so what you're saying that you see the trend not doing it I mean it's more than a trend it's factual by the time they get to being publicly traded zero out of three higher hygienists and if you go to listen to anybody consulted ESO is the first thing they'll say is well you can't pay a hygienist forty dollars an hour to do a cleaning that's fifty dollars from an insurance company right so then you say okay well here's some middle ground well instead of paying I guess forty dollars an hour we'll pay a hygienist forty dollars an hour and an assistant 20 so that's 60 and having to do two rooms so now we're down to $30 an hour and yes who doesn't like that the most so all three DSO is that are publicly traded to have zero the other DSO they t know their numbers and they're not gonna pay you $40 to do a $50 cleaning inside a facility with 65% overhead so the next option would be accelerated hygiene and and they just like well I don't want to hear that so then so so what so what does that leave you I mean where how do you how do you see this
Trish Walraven: well I definitely see that the hygienists are kind of between a rock and a hard place is like if you don't want to work at all well fine we'll just high you know we can't afford you period and then like you said that if hygienists are not willing to use their time a little differently and not work you know one hygienist one chair they are limiting their affordability in practices that are taking reduced raised for the preventive care so they really I I think that unfortunately for those hygienists that don't want to do accelerated hygiene I'm sounding like I'm not much of a advocate for them but there are there are definitely people dental offices that want that continuity where a hygienist you know the patients stay with one hygienist the whole this or one person and that's probably the the key to the hygienists keeping that autonomy is I saw this patient from soup to nuts this whole visit we didn't pass past the you know past them from front desk to hi Jay assistant to hygienist a doctor you know their I took care of them the whole whole visit
Howard: that is that is very interesting so um any we went over an hour anything else that you're passionate about that you wish we would have talked about today um
Trish Walraven: you know I think we really covered it everything pretty well I have a little list here and you you got me through them so thank you for that and thank you for having me on the show well it's an honor I've been a fan years I mean my god you've been on dental town now I'm trying to trying to think here let me pull up you you joined dental town back in 2004 and that was 15 years ago and you've posted 1,600 times I feel like you're my sister I mean I mean really I mean when you read someone 1600 posts and 15 years I mean I I know where you stand I mean it's not like you know it's like this is all repeat that would be hard for you to say something and shock me anymore than it would've any might fight sisters to say something but a big fan of yours love your passion love reading dental buzz calm for just unique I mean you're a dental humerus you think outside the box I mean it's you're really an amazing journalist in dentistry I I wouldn't even call you a humerus I call you a dental humerus journalists of dentistry love dental buzz love everything about it love everything about you thank you so much for coming on the show today it was an honor to podcast you thank you so much it's been an honor