Dr. Koff is a general dentist in private practice in Colorado Springs, CO. He has traveled and done dentistry in a number of countries, starting in 1985 in China - sometimes as a volunteer, sometimes in a paid position. He prefers a small dental practice, one on one to develop personal relationships with patients and keep the overhead low to allow flexibility to take time off and enjoy life outside the office.
VIDEO - DUwHF #1271 - Bob Koff
AUDIO - DUwHF #1271 - Bob Koff
Dr. Koff has traveled and worked in a number of foreign countries, including China, Russia, Madagascar, Romania, and Israel. He currently works part time in Antarctica and Alaska Aleutian Islands and is a consultant for the US Antarctica Program for dental treatment for research and support personnel at the US research stations.
Howard: It's just a huge honor for me today to be podcast interviewing Dr. Robert Allen Koff MD who goes by Bob he graduated from the University of Florida College of Dentistry in 1982 in Gainesville Florida he has been a general dentist in private practice in Colorado Springs Colorado for 37 years he prefers a smaller dental practice one on one to develop personal relationship with patients this keeps the overhead low to allow flexibility to take time off and enjoy life outside the office. Dr. Bob Goff has traveled and worked in several foreign countries including China Russia Madagascar Romania Israel he currently works part time in Antarctica and Alaskan Aleutian Islands and is a consultant for the u.s. Antarctica program for dental treatment for research and support personnel at the u.s. research stations. I posted this last time you made the news I posted it in on dentaltown there's a thread it was called travel to Antarctica anyone been here and I posted that you'd been there and I mean that's just mind-blowing so I wanted to thanks for coming on the show and telling all your dental colleagues whatever how did you ever end up doing dentistry in Antarctica?
Bob: So probably goes back to 1985 my wife at the time was a respiratory therapist and you're probably old enough to remember Project Hope they said a hospital ship.
Howard: Oh yeah
Bob: They retired their ship but they still do health care missions around the world so 1985 as a respiratory therapist they invited her to go to China and help set up an intensive care unit for newborns and so I just gotten out of school was just starting working couldn't join her but the next year they asked her to come back for another month and I said what about me I'd like to do a dental project and Project Hope said well we don't have one and I said well I'm gonna make one outfit and I contacted DENTSPLY and Centrex and if you remember the Columbus Dental and weld and some of the other companies have now merged anyway and I took a bunch of their supplies because I said you know I like to use your root canal system in your rubber dam system and your composites anyway that got us working in China and convinced us more that's any way to travel to get inside the system a little bit meet people do a little work to see the country. So since then we've gone on just all sorts of trips often doing dental work sometimes volunteers sometimes paid and if you fast forward to 1998 I did an eco tour to Antarctica which is typically going out of South America and what was that a Russian icebreaker and you hit different spots and see the sights and see the animals but I learned that the program actually hired a dentist to work six months at their main base called McMurdo and but I came home my daughter was five my wife made me promise to wait till she went to college to take six months off and work so I waited until 2012 and then applied and to me it was kind of the Everest of overseas dental gigs went there and worked six months and really enjoyed it so but I told them I wouldn't do again six months is a long time to be away and be working in Antarctica since then I've worked out that I go for six weeks and I get that work done I end up most the time in McMurdo but fly inland to the South Pole where there's another Research Station there and usually stay there about a week or so. So I was just I would say a way to break up the the normal sitting in the office working off time and type of routine.
Howard: So you said it's the Mount Everest did you ever see Mount Vinson, the highest peak in Antarctica at 16,000 feet?
Bob: No it's it's way far away from the bases so never did get there but at South Pole one you know one of the interesting things you learn when you go and you work there is McMurdo the main base is actually an island off shore so you're at sea level to get to South Pole you fly about 900 miles and you're sitting on top of 9,300 feet of ice is actually where the South Pole sits on a glacier so you end up a pretty high elevation you know in dealing with those issues as well.
Howard: So have you have you ever been to the South Pole yeah I've been there six times now.
Howard: Six times
Bob: Yeah you know so I go there and work that in the summer months there about a hundred and forty people at the South Pole Station they call it.
Howard: So wikipedia says there's four thousand people living in Antarctica and we know that you know the average dentist has about 1850 patients so so for four thousand people you would need to full-time dentists full-time.
Bob: Well that's that stat probably refers to all of the bases of all the countries so the u.s. let's say I'm in charge of maybe 1200 patients at McMurdo South Pole and the New Zealand base we take care of those folks there just down the road the other bases that that number refers to are a plane ride away so I never see them unless they fly through McMurdo and have a dental problem. One of the things suited to point out is that before you're allowed to go and work there you're screened both medically and dentally to be healthy so the the things idea were there things that come up somewhat unexpectedly because they start out in pretty good shape and then you know by the time I get those folks done that have broken fillings or maybe need a root canal or an extraction a lot of people down there would love to have a free checkup in a cleaning so then I end up with a waiting list of folks that I take care of before their contracts over and they leave the ice that keeps me busy for the six weeks pretty much.
Howard: So you're a dental consultant for the US and Arctica program...
Bob: Right
Howard: That's what what they call it and basically that's all done at a base at that McMurdo Station?
Bob: Well so that includes three bases McMurdo's the main base with about nine hundred to a thousand South Pole in the summer is 140 and maybe just 40 in the winter and there's a third station off the coast of Chile called Palmer so a Palmer is only got about 40 people so between those three bases when I'm not there there's a medical team that's usually a physician and maybe a PA and a flight nurse I teach them a little bit of dentistry in Galveston Texas before they go down and then when they have a dental issue they'll call an email and sometimes we'll do a video and try to walk them through how to take care of the dental problem that they're facing
Howard: Yeah well you said one of those stations was I'm by close to Chile and Chile's the closest side next continent Antarctica correct?
Bob: Right right so from Chile to the Palmer station maybe is only a couple hundred miles versus McMurdo is about 2,500 miles from New Zealand which is the closest piece of civilization.
Howard: Wow so you know they say if you live on an island sometimes you get island fever where you just want to get off the island what is the general mood and psychology of a bunch of people living out there in those conditions?
Bob: Well you know it's pretty good idea that they really do a good effort there's a lot of recreation so in McMurdo for instance they have big fat tire bikes and go biking on the glacier they marked it with flags to keep you away from the crevasses you can hike on the glacier if you want you can climb you know a couple of the little peaks in the area there's a big indoor gym we play pickleball and basketball and volleyball they have science lectures in the evenings there's all sorts of clubs to keep you busy there are a couple of bars if you want to hang out at the bars so they really make an effort to try to keep people socializing and you don't feel that isolated really and you know the scenery is spectacular you're looking out on the frozen ocean and the you know glacier cap peaks in the distance and the other thing that again you only learn that when you're there there's a very active volcano about 20 miles away and that is Mount Erebus and so Mount Erebus is always smoking away covered with glaciers but it's got a lava lake that keeps that that smoke going all the time.
Howard: So what are your main challenges being a dentist treating a population Antarctica I mean you know if I run out of impression material or oh it's a phone call away what are your main challenges?
Bob: Yeah you know must I was trying to plan ahead so I bring what I need to do the root canals the extractions the fillings and so it's pretty well equipped you know probably the biggest issue might be if suddenly the equipment were to break down you've got to figure out how to fix it you know make some phone calls look at some youtubes and you know see if you can get it going but you know we have a good IT department we have a good group of plumbers electricians and everybody's pretty well versed and jumps in when something needs some repair and then yeah I've got a good network friends specialists at home then I'll call on sometimes the endodontists periodontist oral surgeons we've got a digital x-ray I can send them an image and say what do you think that's what I think is going on and that's what I think might be the treatment and they helped me through you know some of those issues so you know it's just being comfortable that you're the only guy in town you can't really refer out but you know you don't have any screaming kids issues like that so it's not too bad.
Howard: So what are what are most people studying in Antarctica?
Bob: You know the research that goes on there's some biologic research that would be the whales the Penguins the seals there's a atmospheric research where they're looking at the Ozone layers and clean air issues and then there's deep space so there's this great telescope at South Pole they call it the big bang telescope this is a lot of astrophysics that usually gets way beyond my understanding of astrophysics but that telescope is a radio telescope versus an optical and if you believe the Big Bang was thirteen billion years ago that telescope can look back in time twelve point six billion years ago and tell you the temperature and the conditions a few hundred thousand years after the Big Bang so some of the deep space deception is pretty amazing.
Howard: So what do you...as its the biggest controversial thing now is on global warming you know obviously you see things warming is a man-made is there a lot of global warming research going on down there and have you being a dentist down there changed any of your views in these hardcore sciences of math physics chemistry biology just like dental it'll change your your understanding and comprehension of oral health?
Bob: Yeah I think so I think you really appreciate the guys working on climate change down there usually looking at the big glaciers that are breaking off quicker and melting faster so I don't think there's any issue in their mind about climate change the question is how much are we influencing that so everybody's really tuned into recycling everybody's tuned into not wasting energy you know they they offload 6 million gallons of fuel a year to keep that base going that includes South Pole so yeah I think when you come home you're much more aware of just not being wasteful of energy or resources and so it's kind of nice to be in a community where everybody is tuned into that type of information.
Howard: Do you see you know there's a lot of Elon Musk is in the news all the time and I love you on must because you know there hasn't been hardly any auto companies created in the history I mean from de Muller Benz in the late 1880s to the last auto company just recently I mean it's like 20 guys have started their you know a car company that's made it last but but he's always talking about life living on Mars and I always stop and think well I mean Antarctica on its worst night is 213 Kelvin the dark side of the moon and the dark side of Moon of Mars is 5 it's like well if you why would you go live on a rock where nighttime is 5 degrees Kelvin if you've seen hardly any interest in living in our and Arctica.
Bob: Yeah I agree I'm at the opinion that I want to go live even it you know South Pole the winter there are people that seem to love that darkness and the isolation and the quiet so I think there is a population that has probably signed up for the trip to Mars so I'm not quite ready now I would love to do a little space travel probably more for the zero gravity experience but I still like sunshine and social interaction and the ability to go out and you know break a sweat every now and again.
Howard: So are you the only dentist there I mean are you you know are you working without the advantages of any specialist I mean if you have something it's you or not nothing?
Bob: Right yeah it's just me I'm the only dentist in the program right now typically they've had people that come and go for a year or two but I've stayed with it for about seven years now and you know when I'm not there I'm coaching the medical folks who often have very little dental training you know how to deal with dental issues and when I am there if I have an issue that's a little out of my comfort zone that I'm gonna call the specialist friends that I've made here in town and get their opinion on some things so I feel like I got a pretty good Network to reach out to but yeah you know it's kind of fun to be it's one of the few places where you show up and everybody is really excited about the densest coming you don't get that many places.
Howard: So I assume you're talking to your friends back in Colorado Springs Colorado so you have an internet connection Wi-Fi you have all those luxuries?
Bob: We do have internet so we can do emails and phone calls through satellites I'm considered support personnel I'm not a researcher the researchers get the Wi-Fi and they get the big bandwidth we got what's left over which does not include Wi-Fi so anyway you know we're pretty well connected at McMurdo South Pole is much more limited there very few satellites that are tasked to be near South Pole to give you you know a signal so that you've only got a couple hours a day at South Pole where you can make a phone call or send an email and so you have to plan around it and just make that work.
Howard: and that's because all the humans are living in near the equator so there's just not really a commercial reason to put big communication satellites over that area correct?
Bob: That's exactly the cases when there passing over usually a couple hours a day and the other one I would say they the upside is there's no cell service there's no texting messaging any of that and so it really promotes much more social interaction around mealtime around times where you're not working here you're sitting and talking and doing things with people because nobody's looking at their cell phones or their tablets or anything else.
Howard: Well I was blown away when I saw a while back where 90% of the world's people live in the northern hemisphere with the sweet spot being 20 to 40 degrees north and they have this chart so I mean there's just would be no commercial reason to put a satellite over over Antarctica I mean and and it's hard to justify a South America when 90% of people live north of the Equator that's an amazing fact like people have been complaining about maps since day one that they put the North on top that's why they put the north on top that's where everybody was living and traveling and those maps didn’t include Antarctica for a long time so what type of dentistry do?
Bob: Wou like to do oh you know I'm a typical general dentist so you know I'm fillings exams cleanings even in my practice in Colorado its first of all I do my own hygiene I have one full-time assistant so you know root canals become easier the nickel titanium rotary systems you know our extractions you know for the most part are pretty straightforward so I tend not to like removable so I really don't do partials dentures things of that nature I did implants for a while but I found it really wasn't doing enough to feel like I was staying current so when I'm home I have this specialist do the implants and I'll do the restorative part and I still enjoy that but you know I think I really like the variety the general dentistry your general dentist I assume right?
Howard: Yes yeah so I did 12-hour days this is Wednesday I did 77 on Monday and Tuesday and going back to Thursday and Friday but I'm yeah so it's basically just a family practice and Antarctica and when you're calling your specialist what issues are usually calling them for?
Bob: Oh like I had an issue where you know somebody had a apico that was failing and the question was is there any more and I'm not real comfortable doing apico collect amis or trying to redo it and and this was actually a case I did in Russia and I was working there in 96 and the the last effort was well you can do a implant you know reimplantation pull the tooth out treat it in your hand cut the root put a filling stick it back in and split it for two weeks and so you know kind of walk me through that process and it worked pretty well so that was kind of nice.
Howard: It's kind of interesting I probably did that you know a handful of times I don't know maybe five or more times back in the late eighties early 90s and then it was GG untruthful and endodontists and southern cow that basically schooled me that on apico the highest success rate is always a retreatment you know just try to get in there and retreat it and I'd say and if you can't retreat it now and it goes to an extraction in the implant because you can look at insurance data and that name is just that that procedure has just plummeted to near nothing I mean what was a it was a very common procedure when I got a school in 87 and now it's almost gone the way of the dinosaurs.
Bob: Yeah so you know I have done a few free treatments there was a little tough I had in Antarctica I did I think one or two where I had to track down the chemistry folks can come up with some chloroform and they were a little concerned why do I want chloroform because they thought maybe I was gonna use it on my snoring roommate but I assure them there was a medical reason I needed some for.
Howard: Yeah so University of Texas the University of Texas Medical Branch and they're a big part of what you do right?
Bob: Right so that's who I work for the way if you start money comes from Congress and is given to the National Science Foundation so NSF national science typically hires a defense contractor and it's it was Raytheon for ten years Lockheed Martin got the recent contract they've actually spun off and it's called Leidos as the contract for the Antarctic Program they in turn it subcontracted in this case to utmb Texas for the medical dental portion so that's my employer when I go down as is utmb and you know we convinced him three years ago that there was something to be gained by doing a dental course for the medical folks when they come for orientation in Galveston so this last August was the third time I go down I found a dentist who let us use his office and basically I have them work on each other and learn how to look in the mouth with a mouth mirror how to use the perio probe what a to sleuth is used for how to take x-rays you know on a digital system and just the real basics for diagnostic purposes so that when they have a case you know we can talk intelligently about how to deal with it and they really appreciate it you'd be surprised how well our little dental training they get but how anxious they are to learn a little bit of dentistry because they know they're gonna see those cases.
Howard: So do you want I you know the you don't have anything to compare our system to unless you compare it to another system and I always thought the old time Soviot Union in the dentistry was just better making dentistry especially a medicine stomatology so these guys go through med school and the last two years you may decide to be a dermatologist someone else an ENT someone else to stomatology what I liked about that was the ease of say a dentist can't work with their hands they lose an eye they lose her 3-dimension their view they just go sign up for another residency and a year later their family physician or dermatology or you know something else I thought you know that's a huge advantage that's hard to see and the flexibility of the labor movement within dentistry.
Bob: Right that's true but I've spent I tell you spend enough time in Russia and China their dentistry was so awful no I think China's probably slowly catching up but the Russian dentistry I think was almost like an inbred system where they didn't look outside their own walls so I would say that does sound like an advantage but their dental training was it was so awful that they had a lot of room for improvement.
Howard: and what what years what years were this?
Bob: That was this yeah that was 96 working in Russia and St. Petersburg so yeah it's been 20-something years but you know I I had a dental assistant who was a Russian dentists and the other sister was actually a Russian pediatrician because they were could get paid a lot more in the clinic we were in then working in the Russian system and you know the cases that would come in you just see a lot of awful dentistry you know they just were not they were doing composite because they like the aesthetics but they weren't keeping it dry you know during the process so they were guaranteed their work for 12 months and after 12 months all bets are off they were still hammering crowns you know they call them switch crowns they kind of put him on the hammer and then crimp them had to come at the margin so you know hopefully some of that change but I think you know the average dental care in Russia is still pretty awful so they've got a lot long way to go in those things.
Howard: and how do you and how would you compare the Russian system to delivery of dentistry to China do they have more similarities coming from more centrally planned economy than say Western Europe and Australia and Canada United States with it more economic free enterprise delivery?
Bob: Well you know Russia's a democracy and China's communist but in truth I think China's got more free market systems going today then Russia does and I think part of that is the Mafia is still alive and well in Russia and really makes it very tough for private business to get going and you know and use any modern equipment so I think China is probably more advanced than Russia at this point in dental care because they've been exposed and they've been much more able to adapt to the newer technologies than the Russians have you know I think Russia is so having trouble feeding itself.
Howard: Yeah and their population hasn't even recovered from World War two that that's the most shocking I mean that the losses they had in World War two was like 20 million I mean the fight for Stalingrad which was now renamed bull bull bull go grad or Volga City I mean I mean you look at the amount of men I think the median average age of a soldier in World War Two is like 23 so the complete disappearance of all the Russian boys around the age of 23 the you know 224 their population hasn't recovered I mean it's just so amazing that you know that 70 years ago it still has a massive effect on so via and their psyche I mean after taking I mean people always want to know why they're so you know militant I mean my god after surviving that if they weren't militant I mean it'd be like NASA not caring about asteroids you know I mean you think after the asteroid thing they would we're talking about living on Mars and start trying to figure out how what they're gonna do with this slight asteroid issue and these five paths extinction-level events who cares that there's some slime mold growing under Iraq and Mars but yeah so you see the dentistry when you're in Antarctica what what dentistry do you become aware of do you see other camps other dentist?
Bob: I don't think any other base has a dentist almost all the other countries will train their physicians for at least a couple of months to do emergency dentistry typically extractions and maybe some temporary fillings but I don't think other bases hire a dentist at all so I used to joke that you know I'm the only dentist on the continent type of but you know once a while I think I've had some folks from the Italian base and from I'm trying to remember from maybe the Polish base come by and you know their quality of Dentistry is lower than you know what we're used to seeing and I mean even New Zealand you know New Zealand dentistry was pretty much based on the British social dental system so there's still a lot of amalgam being used there still I would say just much lower quality of care overall coming out of a place like New Zealand but at the same time the population is kind of used to that they'll probably take a few generations to really change all that and so you know we try not to impose our our thinking on on other cultures but you know you're offering if I see somebody from another base because they're having a problem I'll tell them what I see is going on and ask if they want to treat it and sometimes they do sometimes they don't you know they they're willing to live with much more I would say discomfort than we're used to.
Howard: Wow they're they're willing to live with more discomfort that is a that is a interesting statement. So back to the you said I used walked into a Pandora's nest with a word of a mountain I mean if I was gonna have a filling done today and then I was gonna go be in Antarctica you know a continent with only 4,000 people and very challenging to get back wouldn't amalgam be the wiser restorative material then composite?
Bob: Well yeah you know it it'll probably be more forgiving and maybe even last longer but you know it's in people's minds it's really fallen out of favor for the aesthetics and for the environmental aspect you know when we were looking at it in Antarctica we were actually very happy to get rid of all the amalgam supplies between the mercury and thing it was like the x-rays to all the fixer and developer would get rid of and just deal with a digital system so I think environmentally you know without amalgam you don't end up with that mercury in the water system and then problems like that so that's that's the trade-off you know if they're done well you know composite is close enough that you know it's not really an overriding issue in a setting like that.
Howard: Well dentistry is kind of a it's a running joke on dental town since 1999 not in my hands where where people want to dismiss like a hundred million insurance claims and say amalgams last longer than composites and so when the entire planet of two million dentists all claim not to be a part of that data you know I mean the two million dentists all claimed that theirs last longer but somewhere between a hundred million insurance claims and two million dentists some somebody's looking at this as a bias rumor. So how is practicing in Antarctica changed your own personal view of mercury algum what did you experience down there that you didn't experience in Colorado Springs?
Bob: Oh well I stopped using amalgam here you know probably 15 or 20 years ago so before I went to Antarctica and I think it's just you know reinforced from an environmental standpoint you know if you've got a better material like composite or even gold I still do a lot of gold you know gold crowns and things like that I think it's a better choice you know we're still taking out old amalgams obviously and that becomes an issue but I think you know as time goes by that'll be less less and less.
Howard: and they haven't even started a global discussion of the other issue of mercury like when everything I'm reading is not you know we place them for a century so they've got to be replaced for so that's the water and everybody talks about the traps and you know there was debates about should the dentist do it or this city should do it and obviously the dental office should do it I mean everything you don't do to take care of yourself or your own business you just you're just forcing a mandated government solution but they haven't even addressed the issue that the worst part of it today is the cremating of humans and I've been reading like 6% of all the atmospheric mercury pollution is because of cremating a human with remaining silver fillings and when I read that I always feel sorry for the Crematory guy because you know when he opens that oven after that the cycle that he just takes the biggest most concentrated blast of mercury elemental mark of everyone so on have you even have you heard anybody any of the scientists down there talking about banning cremation?
Bob: That's the first I've heard of it you know we used to joke when I you know you did Proust anatomy in dental school probably like I did but I remember the teeth that had gold fillings suddenly disappeared at some point because somebody in the lab got hold of them you know the tournament for the goal you know which is completely unethical and illegal but it goes on time I'm sure so that would be a good point to address that would be to take out any teeth with amalgamated before the cremation I wouldn't seem like a tough mandate right.
Howard: Yeah and I think cremation is one of the biggest I mean you your life is over and the last thing you do is flip off the entire biosphere by not returning all your elements and molecules and compounds back to mother nature to be recycled I mean my gosh we take fish out of the ocean but we don't even replace it with our poop after we're done digesting it so that everything on the bottom can feed you know the eukaryotes Pro carry everything that would nourish that the fish at the top and create cremation you know to take that human being and just turn him to energy to be bounced off into the cosmos is just like I mean that's just I mean that's the craziest thing they should be buried in a something that'll recycle and return themselves to the elements that would solve the the cycle of biology and it would solve the atmospheric pollution from the mercury
Bob: No that's a great I think composting in some form without the crazy expenses of the funeral and the casket and all that make a lot of sense
Howard: Oh and they're so predatory I mean dentists by nature that they hate cells I mean they just they they see it as a scientific health care provider it's all surgery done by an opteratory or they hate selling the mandos those funeral alms there well you know what flowers aren't you and the voice they say it it's like if you said no amends that the person dead was meaningless I mean it's an oh my god and then it's always the poor people they don't have the money and then they finance it and they're paying interest it is a racket. What I think is what most dentists listening to this would find the most interesting me you chose Antarctica but they're looking at you thinking dude how do you how do you structure a dental practice where you can have a relationship with patients cuz I reading your letter that you send to them and it's just the first three words sums up you didn't say dear patience dear patients and friends I hope your summer has gone well and you're ready for another season a cold snow and are envious sunshine in Colorado in addition to my dental practice here I remain the dental consultant for the u.s. Antarctic Program recently they offered me a six-week contract to go down and take care of the dental needs of the researchers and staff at McMurdo McMurdo and the South Pole so I'm heading south in early January while I'm away I will forward my phone and refer my practice to Dr. Jack Mathews who I've known for the past 30 years and shared an office with since 2003 you gave him your personal phone number I encourage you to call and take care of any dental needs that arise on the way. So you obviously have a great relationship with jack back at a home base but your your friends and they they don't look at this well you're it's selfishly inconvenient for me and I got to see someone else I'm just I'm just gonna cross you off the list and go to the next available dentists and you don't seem to have that issue with your patients who you addresses friends?
Bob: No I think I learned that lesson in 1991 we decided to take a year off you know 12 months of travel put together a bunch of dental projects between Central America and Israel and Romanians from other places and people said you can't do you can't go away for a year and I said well we'll find out and that was before email so I wrote a letter similar to that I wrote another letter in the middle hope you're having a good year and I'll see you in January you know 1992 and then a third letter about three weeks before I came back and what I learned was that yeah you think I retained about 95 percent I lost a little bit but I don't think any more than you know the comings and goings of people moving or changing dentists and I think we're able to turn it into what I would consider a positive marketing thing where they say hey my dentist is the guy that goes and you know work volunteer in Israel and goes to Antarctica and treats those guys and I have a photo album and now the website of different trips we've done so I think people like to come back and hear the stories as much as anything and so it's encouraged me I guess to do that and the really interesting thing too from a marketing standpoint is you know just a couple weeks ago you know the schedule was getting a little a little slow but I knew it was about time to send out the notice that I'm going away in this case three and a half months to Antarctica and as soon as I send that out on an email it creates this sense of urgency and I get all sorts phone calls from patients well all I want to see before you go away then you know though I haven't seen maybe in a couple of years and so it fills the schedule up you know it all seems to work out pretty well that way.
Howard: So you know we we create you know are the stories we tell ourselves creates our problems and here you wanted to take off a month or three months or an entire year and you just successfully communicated that mission and that purpose and that value with your patients and I'm not surprised they thought it was cool and they probably made them have a deeper relationship with you.
Bob: Yeah no I think there's some truth to that and again I think if you develop enough of a personal relation with people that I've you know in some cases I've seen them in their family over 30 years you know it's just a very nice relation that they want to sync with you yeah I've also learned that you know dentists sit below hairdressers for women especially because I'll get calls every you know I gotta change my dental appointment because that's the only time my hairdresser out I gotta go see them you know and reschedule the dental so it's all about trust in relationships and and how that goes forward over time.
Howard: and their values whether you agree with them or not it doesn't matter they're their values and they're not asking you for your values I've had twice this month where someone said no I can't do anything I just spent five thousand dollars across the street on my dog and when they start telling me about their dog and this lady was telling me the story and I did I mean it was just so bizarre that I mean she was talking about this dog that you know should have a life expectancy at 12 to set I think she's had 12 to 17 years and she knows it's 21 years old so she don't accepted all these things that hadn't slowed her down a percentile in throwing every dollar in cash and technology I came in when she showed me a picture of it I mean it looked like a wet rat and you know so I remember in dental school I had that that first it was one of the first things that stung me was when he said you know people will you know spend $1,000 and taking their family to Disney World but they don't want to save the tooth and I actually interrupted I said what was the point of that I mean that a father loved his family so much he wanted to spend time with him at Disney World that he sacrificed his only permanent molars I mean this is a romantic story right we should should we clap cry and and you're you're talking it down and it's like I just thought that was bizarre just like another instant I went to that I see that you've gone to to was talking about you know the A patient B patient C patient D patients and and when he said you should and then he described the whole thing and then when he was and then when he when he said that that you should just work on a patient's I thought okay well my entire pedigree fits in that C,D,F so what he's saying I graduated dental school and turn my back on my family and that was kind of my love affair with Rick Kirchner another dentist in Florida where he was just paint I mean he was just only focused on the lower-income market and he couldn't care less what you were doing at your mercedes-benz dealership and then whenever he complained about his he's like you don't even make a used car you don't even make a basic Chevy why are you why are you even looking at my model you're not even addressing that model. So you you probably are well where Ricker Kershner growing up in Colorado.
Bob: Yeah
Howard: Is he would you say he's the most controversial dentist in Colorado State history?
Bob: No that would be
Howard: Hal Huggins so what so to the young listeners that quarter of our listeners are still in dental kindergarten school they probably never even heard of Hal Huggins you live you and I lived through it but you were a lot closer now what was your how would you describe that career to the next generation of replacement dentist?
Bob: Hal Huggins was the CEO of the mercury crazy man and you know there was a dental colleague who had a broken amalgam and decided let me I'm gonna go to Hal and because how it worked here in Colorado Springs when he was so lot and and see what the processes so he came in and they oh yeah you know we're gonna replace you know this this awful silver filling and you know replace it with this so they set it all up and and he had some kind of garage made a meter of some kind that he could measure claim he could measure mercury levels laying around the day my friend wind went and he had his filling replace and and then it came back later to check it all and the things didn't check out the way Huggins had predicted and so he starts questioning and he suddenly jumps all over when he's old you had orange juice for breakfast that's what screwed at all so you know Huggins was I think a real charlatan who appealed the some people but it certainly was not respected in the dental community and you know I've had patients and you probably had patients to say I want to replace all my amalgams what do you think and I said well my opinion there's no scientific evidence to to back that out but you know if you've done some reading and you feel like it's you're an informed patient and then let's say I had one case a woman who had been diagnosed with chronic fatigue you know this is one of those things which means we don't know going on you know she was kind of grasping at straws and I said you know I'll do it I think she had four or five amalgams but as long as you understand I don't expect any improvement if you do get improvement that's great but that's not something we can count on so you know that's my feeling with amalgam when when they break down and need to be replaced that's a great excuse but otherwise I've seen some that have been placed 50 years and look great.
Howard: Yeah the the mercury thing is so emotional I mean I I'm you're talking about your patients bonding with you because they I think they feel you had a greater you know interesting purpose and you know not only were you their local dentist but you were a dentist for those in Antarctica. I remember and I opened up my practice I I had a hard time psychologically getting motivated because it was just painfully aware that I was practicing in Phoenix which at the time was the third-largest unfloradated city in America so we blocked off Fridays for what I thought would take us six weeks to fluoridate and it's at like two years and I really thought it was so cool how I'm the patients I really thought that was cool the the staff really thought it was cool it just kind of set the it just kind of set the table straight and I'm on Hal Huggins I'm reading the summary administrative law judges conclusions about how H Huggins DDS oh but back to the floor I deal that happened a quarter of Phoenix was just they they didn't understand how to approach mercury like they would bring in to me and show me like a rat poison or something they bought as a poison for insects or whatever and they'd show me how one of the ingredients was fluoride and I'm like yeah there's 89 naturally-occurring elements on earth and that's one of them but they didn't understand that you know water could you know that in biology it's all concentration it's all it's all how it's done but yeah 1995 the Colorado State Board of Dental Examiners held 12 days of hearings related to complaints brought against Howell Huggins on 29 1996 law judge Nancy Connacht recommended that as license should be revoked Huggins didn't appeal and that was the end of that charade. So do you think so you think deep down inside he knew this was Charlotte's and territory?
Bob: Oh it;s so hard to tell I unfortunately think he probably really believed he was doing the right thing.
Howard: but so I mean but that's the whole definition so I mean so you believe that deep down in his heart Hal Huggins thought he was doing the right thing and was everyone else just didn't understand as opposed to I know this lady is you know the funeral parlor I know you just lost you know your spouse oh I know you know I can sell you on all this stuff so you think in his heart the best of your knowledge in his heart he thought he was doing the right thing?
Bob: Hal ye the funeral thing I think no I think they're looking at bottom line dollars you know when they're trying to sell you know the funeral services but I'd love to sit for a second just talk fluoride since you brought it out yeah I don't know if you know the history of Colorado Springs his word fluoride was discovered to be what it in is we are the biggest city now in the state of Colorado that does not have fluoride in its water.
Howard: and what and what do you so to tell the kids the story because I'm yeah that was an amazing story so basically my understanding of the story and I think I've read I might have read everything that was on PubMed I mean I think at one time I had 5,000 printed out PubMed citations all organized in my notebooks because you know you would and be called to these debates and you know and but basically they noticed that some areas in around where you live in Colorado and Texas they had a really low decay rate and they were also dark brown and they never ever considered it was fluoride his back then they couldn't measure parts-per-million so they were only measuring you know maybe parts per hundred or parts per thousand and it wasn't until they could get six placements over at parts per million where they started to see it starting to make sense is that how you view this all right?
Bob: So Mackay was a periodontist 1908 he was the one who was credited with noticing and it was called the Colorado brown stain that his patients with excessive brownness weren't getting cavities he spent 20-something years he figured out it was fluoride that both caused the brown stain and the decay prevention causing the Public Health Service so it was I think you know that said that somewhere in the 30s or 40s they confirmed it was fluoride they did the studies that said could we use less you know and came up with one part per million would get the benefit without the fluorosis and so but I think it was Grand Rapids Michigan that's right yep was the first city tart officially add fluoride did the studies before and after showed a 70 something percent reduction indicating kids as a result of water fluoridation that became the standard but what's changed in Colorado since then is our city now imports a lot of water from other parts of the state so the local water which is still too high they actually removed the excess fluoride and it has the right amount but two-thirds of the city that imports its water now I think it's at point two parts per million at best and so I think we see higher decay rates I tried to get the city to to consider adding fluoride in 1998 they agreed they built a fluoride system and one week before it was going to go online the opposition showed up made a big fuss and so they never turned it on and so they spend 2 million bucks to create fluoride systems that have never been used and it's really unfortunate that it's that controversial because to me it's no-brainer.
Howard: and what do you what do you how big is the controversy I mean what percent of Americans do you think are not into this and don't want in the water and what do you think the main reasons are?
Bob: You know the reasons that I've seen the anti fluoride groups that it's poison in high concentrations which we agree with you know there was some study that supposedly said you know even the regular fluoride which is now at 0.7 parts per million that's the recommendation you know causes lower IQ you know some study came out that hinted at that and so they grabbed on that in the in our case the the argument they used that unfortunately swayed the City Council was the you know hydrofluoric acid which is one powder form that's used you know across the country you know is a byproduct of some pollution scrubbers you know it just completely you know getting that did you know out of context but that was enough to create some doubt and it's simpler if you remember do you remember the recent controversy is dental-flossing useless and it turns out that story as I remember it was the company that says you know we like to give our certification an endorsement but we've tightened our regulations so flossing no longer meets those regulations because there haven't been enough studies that got interpreted that flossing was useless and it was incredible how people latched onto that without really understanding the nature of the story.
Howard: Yeah and I think it took their mind out for a five-mile right that we operate in a comprehension where a lot of things can't be proven on a randomly controlled double-blind study I mean I think of all the human rights atrocities we would have to commit to put everything we believe about human health dentistry diet nutrition I mean it would it would be it would be crazy crazy to say. So what is your uh what is your long-term perspective now I mean when are you going back to Antarctica how long do you see yourself doing this?
Bob: I'm heading back end of November I'm gonna actually go to the base I mentioned off the coast of Chile is called Palmer and they've never had a dentists there because it's such a small base usually they just put you on a boat back to Chile if you had a dental problem but I convinced him I could do some training and bring some new equipment so I'm gonna go to Palmer for the month of December and then I'll turn around and go back to McMurdo and South Pole January and February so I'll be gone about three and a half months this time from late November through you know March and then come back to work and I at this point I kind of look at it maybe every year I'll take a look and if I'm still enjoying it I don't know back and do it it's it's similar to there's a non-profit I do some work in the Aleutian Islands in Alaska so I told them you know I'll go for a two or three week contract once or twice a year you know they'll fly me out just someplace along the Aleutian chain and yeah it's just an interesting setting you're working on you know a fair amount of Native Alaskans here me some interesting expats and you're spending some time in some beautiful scenery.
Howard: and what is the next pack what do you mean by expat?
Bob: Oh you know an American whose who's living in a pretty foreign setting you know running a grocery store on a little island of 800 people that's a fishing community so you know that's not where the drama that's not where he you know has as family but you know for some period of time he's decided to live in that pretty much foreign setting to experience that sometimes with this family.
Howard: I thought the most interesting when you said expats the first thing I thought of is when I went there with my dad and my brother we flew into Anchorage and we drove down to a home Erwin halibut fishing Kenai salmon and then turn around drove all the way to Prudhoe Bay and I just loved Alaska but it was the meeting of Russians I mean I mean we bought that from Russia in 1867 right and my gosh all those Russians live it could you imagine living in Colorado and you wake up in the morning and oh we sold our country too and now everything's in Russian and I was just talking to this person and it was just so mind-blowing that her entire community was Russian it was in a little village between homer and Kenai and I talked to I was talking to other dentists there when I let you there and he says I said you know do you have friends there do you know people he goes now I kind of don't want to go in there and you know I'm I I don't belong and I just I've never done that but I did it because I'm just naturally inquisitive and stupid and didn't think of the risk but my gosh that was just so mind-blowing for me my dad my brother Paul to sit there and think what they must be going through and they still want to just have their Russian community and they didn't really so when the internet came out and you start googling you find out that a lot of governors have just just given him a pass you know what I mean when they don't agree with some it's like just leave them alone that you know they're going through something traumatic and you know just like the American Indians even today are experiencing trauma understanding their past it's a and some of the American Indians are very traumatized with it. So interesting stuff so I wouldn't believe it's already been an hour but I want to talk about your special relationship with John Matthews because what is that like for talk to young kids because I was when these they want to learn implants I would say we'll walk across the street and tell that to your periodontist why are you getting in a jet and flying to another state and drop in $3,000 when this guy actually would probably like to have a friend and a buddy and you know he's right there and then whatever you didn't pick up correctly in class you know you got a friend to bail you out but they're just my homies are you know to get naturally select in dentistry that what comes with the a in calculus and geometry and trig means that it's hard for them to develop these types of relationships so how did you and John form a relationship where you can just say hey buddy I'm leaving for a year best of luck to you and he and he shakes your hand?
Bob: Yeah so John goes by Jack and you know I my whole career I've always leased space in somebody else's office so I've been but I've always had my own practice so we pretty much call that space sharing and I've done it 1 2 I guess 3 times you know in the course of 30-something years and it's always been a very nice relation to have another dentist to share an office but still feel like I had the autonomy to have my own practice and do it different ways but now we can share ideas and share philosophies and cover for each other when we go away so you know Jack has a big practice probably eight full-time people he's running one or 2 hygienists a couple of assistants and he's happy there you know working away and at the same time I think he he likes our relationship and he likes to help me out and he really does help me out to be there knowing that I like to go away and do these kind of things so it's a matter of just finding the right person that you know can respect you know something a little different than the way they're doing it and you we still have enough common ground that it's always very pleasant to sit and talk about you know cases together or things like that.
Howard: There's a there's always a thread going on this issue there's one that's active today about space sharing is there any economic framework you that you've learned over three decades that you can share with the young kids because basically the conversations are always the same thing I got a dentist's office you know it's a complete dental office but I only use it Monday through Thursday I'd like to rent to a specialist to come in on Friday or Saturday all the way to just space sharing where I want to share all this overhead but my practice any technical lessons that you could pass on to the young?
Bob: I think you gotta just be honest for each other you know Jack and I have been together for 16 years and it's on a handshake and so we don't have a formal contract we pretty much just have an understanding as long as we get along and we understand each other's needs and wants and I'm helping cover his overhead basically but if for some reason the relationship wasn't working then you hope you can part friends without talking to lawyers so you know all my space sharing have always been on a handshake with somebody where we sit down and just talk as friends about I'm looking for one OP to work with I need a little office space for my stuff I need enough space to put a laptop computer in the OP from my digital system and and other than that you know I would just like a friendly safe environment to work it and you know just just find somebody that understands that and you know is willing to help you out.
Howard: and if you think that sounds really strange and foreign well that's how most dentists go into their marriage I mean almost right I don't know anybody has a prenup I actually well I know a few but not very many have a prenup so you went in with a relationship your word-of-mouth based on trust and mutual respect any economic parameters that you can share?
Bob: I think for me it was the question of okay I'm not building equity in an office or the equipment so you know I figured out really I'm gonna save money on the side you know we're gonna in an IRA type setting you know that's gonna be my retirement it's really not gonna be my dental practice for the building or something like that so I think as long as you have an economic alternative to what you know some people have the office and the real estate you know I think it works just fine and then to meet the trade-off is that I can take time off and my overheads very low.
Howard: Yeah and time is uh so much when you have no money then you sacrifice all your time but once you have money time is the most precious but back to economics did you pay him a percent of your production to use that space or?
Bob: No you know I'm paying him I think about thirty two hundred bucks a month to you know to use one up but you know the rest I have my own phone lines I have my own staff his staff will answer our phone if we're tied up but you know it's pretty much just a straight rent fee that we agreed on and by the time you crunch the numbers that all works out pretty well yeah where I can make a living and support the lifestyle I want and I think it helps cover his overhead as well.
Howard: So you're um and by the way to the kids out there I mean you know when you pay $3,200 a month that that's renting when you say I have to give you a percentage of what I do that technically is fee splitting and is a very complicated issue because in past abuses over the last century state boards have come to the conclusion they don't want a family physician referring someone to say a surgeon for a procedure and getting a kickback because then they saw data unnecessary incense of surgeries so these splitting can be very dangerous, I've seen that I've seen two dentists in my history here in Arizona they got taken to the cleaners for that type of legal framework so you just pay a flat rent regardless if you see one patient or 100 or produced one dollar or a million dollars, it's just the same rate so you say you have low overhead you just have how many employees do you have?
Bob: Just one by one full-time assistant I do my own hygiene so you know between my assistant and myself and Regina has been with me I think about 18 years now and she's happy to take time off and not you know getting any salary when she's not working so that's the key to finding somebody that you know beats that criteria that if you're gonna take time off it's not a big deal.
Howard: and what is uh and what you use the same software to run your practice in Colorado Springs as you do in Antarctica is or what is your digital system look like?
Bob: Yeah I actually don't have a practice management software I still just we use paper charts I mean the only digital thing I have really is the x-rays so we've got the nice x-ray system but the rest is all done on an Excel spreadsheet you know you know I used to have the pegboard now I just put it on you know an excel sheet you know our recall system is either post cards or emails you know I really have not gone high-tech with the practice from that standpoint and Antarctica is very similar I mean it's just writing up paper charts we don't have an electronic medical system down there and we have the same digital system so that's easy.
Howard: What would you say your overhead is?
Bob: Oh it did sits right at about fifty percent.
Howard: Fifty percent
Bob: Yeah
Howard: and so yeah the low range of the overhead fifty percent you don't have much HR issues you only have one employee my gosh you have unlimited time off and my gosh I mean how fun it shows dentists can create their own destiny and I know so many dentists I mean so many where a dentist does his heavy lifting what he calls jennipher decent George call you know rocks and water do your heavy rocks in the morning root canals or kind of bridge or whatever and then when they have been fillings then when they come back from lunch they just do hygiene and they have anywhere from zero employees to one and they might only produce you know they might only collect like say 400 but they'll take home two hundred and then the guy across the street is doing a million rollerblading around just working like a crazy man and at the end of the year he might he takes on one eighty and yes is there anything wow this one guy in in one op and with an emergency room so to ops with one employee is netting more money than the guy across the street he looks like he's gonna have a heart attack.
Bob: I think that's it I think it's worth certainly taking a look at that because I've seen examples of that and the guy running around really can't afford to take time off he costs too much to be away from the office so I think I figured that out early on that I could fund the lifestyle I wanted so take a lot of time off.
Howard: So if someone wants to learn more about you and everything you're doing is do they go to frozendentist.com?
Bob: Yeah that's the website that gives some background but you know I'm surely open to emails and phone calls and you know give them some background if they want to know how I do it.
Howard: and how would you what are you willing to share for emails and phone calls?
Bob: No my office phone is seven one nine five nine three nine three eighty eight and my email is his old fashioned is again it's bobkoff@hotmail.com
Howard: Well that is a bobkoff@hotmail.com I loved your website frozen dentist I mean when I first saw this new store I said I want you to come on this show and talk to these kids because um they put so many limits on what they can do with the sovereign profession of Dentistry and my god there's ten specialties from A to Z there's there's what you're doing I just think what you're doing is man it's so exciting a lot of times it just gives dentists hope. I know a good friend of mine in Phoenix here where he you know kept thinking when I retire I'm gonna get a sell boat and sail around the world then he started realizing well would I rather do that when I'm 65 when I'm 45 and then they realized I it'd be a lot better to be you know a Sailor man and a younger body and so he just sold his practice and thought he was gonna sail around the world and end up didn't stop sailing for seven years and then when he got all of his sailing Yaya's out he came back and now he's practicing again and all's good and I mean how many dentists just takes seven years off in the middle of their career you took a year off intel has a program where every time you every seven years you work they give you a paid six-week sabbatical to go do something other than work go take care of yourself nourish your brain and so kudos to you, you're the only dentist I've ever met heard of or talked to that practices in Antarctica thanks for coming on the show and sharing your dreams and stories and I hope it motivates some kid to think outside the box.
Bob: Hey thanks so much Howard.