Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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1303 Profitability through Efficiency with Dr. Matthew Krieger : Dentistry Uncensored with Howard Farran

1303 Profitability through Efficiency with Dr. Matthew Krieger : Dentistry Uncensored with Howard Farran

12/2/2019 6:00:00 AM   |   Comments: 0   |   Views: 239
Dr. Krieger is a 1998 graduate of New Jersey Dental School.  He started his private practice in Franklin Lakes NJ in 2002 from scratch.  In 2019 his revenue will approach 2 million dollar at a 40+% profit margin.  He works less that 28 hours per week, has a total of 4 operatories with 3 FT hygiene columns, and accepts PPO’s.  He started Million Dollar PPO Coaching and Consulting in 2010 in order to help dentists understand and grow their businesses in today’s new and challenging environment.  He believes in profitability through efficiency.  He and his coaches have helped hundreds of practices throughout the US grow and thrive.  He lectures nationally on practice management, CAD CAM integration, and the business of Dentistry.

VIDEO - DUwHF #1303 - Matthew Krieger

AUDIO - DUwHF #1303 - Matthew Krieger

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Howard: It is just a huge honor for me today to be podcast interviewing Dr. Matthew J Krieger DMD a 1998 graduate of New Jersey dental school which is now called Rutgers. He started his private practice in Franklin Lakes New Jersey in 2002 from scratch in 2019 his revenue will approach 2 million dollars at a 40% plus profit margin. He works less than 20 hours a week has a total of 4 operatories with three full-time hygiene columns and accepts PPOs. He started million dollar PPO coaching and consulting in 2010 in order to help Dennis understand and grow their business in today's new and challenging environment. He believes in profitability through efficiency he and his coaches have helped hundreds of practices throughout the u.s. grow and thrive. He lectures nationally on practice management cad/cam integration and the business of dentistry at the core of his philosophy philosophy is profitability through efficiency he believes there are five factors that affect efficiency clinical skills technology team and leadership systems and marketing new patient acquisitions. What he teaches he uses practice, an office does not need to participate in PPOs to benefit from his core values improved efficiency in any office will foster higher quality and profitability. Through various products services and programs he provides the knowledge and tools necessary to assist doctors and teams to create the practice they've always dreamed of in deserved. He's an active member of the a daa-daa CD as he earned over 600 hours in CW in all aspects of clinical dentistry he's been married to his best friend in high school sweetheart Sheila since 2002 they have two beautiful daughters Alva and Madeline he enjoys golf cycling travel and most of all spending time with his amazing family we expect every day as a team of energetic professionals to earn the loyalty and trust of our patients who will turn appreciate who will in turn appreciate our valuable time. You know Matt it's everything you're saying is the opposite of whatever II wouldn't say and everybody drop insurance go fee-for-service build the Taj Mahal treat the lifestyles of the rich and famous and here sounds like you're some middle-class blue-collar New Jersey boy who learned how to make money off the middle-class. I would rather own McDonald's than Ruth's Chris but I think most dentists want to go to the Pankey Institute and learn how to make a five-star dining restaurant for lifestyles of the rich and famous but I'm asking you would you rather own McDonald's or Ruth's Chris?

Matt: I would rather own McDonald's as a corporation I don't I would definitely like to cook like they do in Ruth's Chris for myself and and perhaps for guests from time to time and I enjoy Ruth's Chris I was at Morton's last night for a steak but there are certainly more people in the United States who can afford to go to and who choose to go to McDonald's on the regular by the way then do go to Ruth's Chris so the competition for unique patients at the roots at the roost Chris style level is going to be way way more challenging than the competition let's say at the average as you refer to kind of middle-class blue-collar family. You now understand of course middle-class blue-collar where I am in New Jersey is a family with a moderate six-figure income you know New Jersey is a very expensive cost of living home prices are high tax dollars are high you know state tax is almost 10% here real estate prices are extremely high so here and I think everywhere else middle-class blue-collar is a family that has a nice income whether it's here quite frankly or anywhere else my practice is not made up of patients that don't have money or don't spend money it's made up of people that are not ultra rich and do not choose to who do not choose on average to spend the tens of thousands of dollars in cash at a whim on dentistry but my patients spend money on teeth as they do on hugs boots and cellphones and risk wrist dinners from a business standpoint I want to own McDonald's or I like to say I'd rather own Hyundai than Mercedes I happen to like Mercedes as a car but if I'm here to make money Hyundai makes more so does Honda so this Toyota. I think dentists have a challenge in their identities in dentistry you know they they all graduate with this desire to gaze upon the beauty of their amazing crowns and go to Pankey in all those places but most people walking around Howard don't think about teeth the way dentists do I've just figured out a way to serve the needs of the people who come to my practice give them what it is that they want at the highest level I can at a reasonable price make them feel happy in my team feel happy.

Howard: and by the way a lot of those people who teach this Wow quality mercedes-benz dentistry and they say they have a private practice doing this if they're really rich and famous doing this you go into their office they're only treating dentist you have to be a dentist to have value this type of Dentistry and have the money to pay for but it's a lot of the things that we I went to Pankey just because I found it extremely fascinating but that doesn't mean that everybody in America is gonna value the same thing you thought you talked about there are five factors that affect efficiency clinical skills technology team and leadership systems marketing new patient and acquisitions and dentists they only want to learn clinical they just were bone grafting and so talk clinical but let's start really critical since that's the only thing they want to listen about anyway.

Matt: Funny because it's to me it's the thing that least generates success after a certain level in dentistry once you kind of for the average practitioner once you have been become competent to meet the standard of care and provide quality dentistry to patients once you're able to do crown and bridge and restorative dentistry and solve the average need the success of your company has little to do with teeth and and the procedures and how advanced you are but more likely how you run the company you know clinical dentistry is really important and I like you Howard I I believe that you should strive for excellence in clinical dentistry my suggestion however is that you're striving for excellence probably has more to do with your own internal drive and ego than it will to produce for most dentists a major change in the success of their business. Most dentists do not have clinical practice problems most dentists have business management and operational problems they look at the world through dentists eyes so they can't relate to how their patients really see them.

Howard: Yeah and they and they talk very differently than physicians I mean there's a million physicians United States there's 211 thousand Americans alive with an active license to practice dentistry today so there's five times as many physicians but when you go to dinner with physicians they never talk about the Pankey Institute or they never talk about their new MRI machine or their laser their CAD cam it's just that type of stuff just pretty much all assumed I mean you usually but go ahead.

Matt: No I mean it's interrupt you,I agree.

Howard: Yeah yeah I mean I mean I I just find they're there it seems like dentists want to validate themselves and for me to be a good dentist I have to have these alphabet soups behind my name but you don't look at I don't know of any my md friends have anything behind their name other than just md they don't have MAGD FAGD, you know they don't have all this stuff I've never heard him say oh I'm really excited about this do you know $100,000 machine like a laser or CAD camera they never talk about technology equipment alpha behind the deals that they just talk about patients and diseases and all that kind of stuff. So do you think I'm when you say there are five factors that affect efficiencies well what would should they know about clinical skills to affect their efficiency?

Matt: Well what they should know about clinical skills are which skills are the most important skills in today's environment to grow your business I mean what should they be focused on. Howard I just came from a client of mine in in Sarasota Florida young guy starting a beautiful practice he's going to be an amazingly successful dentist I have no doubt about it he's 29 years old and his he's consumed with and perhaps rightfully so all of these porcelain techniques and advanced you know serac bonding and how to make these beautiful anterior static crowns and all of these alternative means for creating amazing dentistry but he can't do an extraction, didn't learn that dental school it doesn't place implants he doesn't provide bone grafts you know the Bolar endodontics are challenging for him sohe has these patients coming into his office and they need you know two crowns and an extraction of a molar and a graph and a membrane and an implant and he's only able to address you know 20 to 30% of their need to extract 20 to 30% of their dollars and runs a tremendous risk of losing them to the specialty nebula out there where they go to the surgeon and return in six months or go to a periodontist and never come back and more than that what if the patient's chief complaint Howard if I came to your office and they said I have a toothache my tooth hurts on the upper right and I think I needed out what I want from you is to take it out what I definitely don't want from you is an explanation of why it needs to come out and then a little piece of paper that tells me where I can go when I can get an appointment there for someone else who's more qualified than me to do what it that I need. So my experience of your business is so what have you done for me lately I came here for you to fix me you can't do it someone else can and so clinical skills to me means having the capability and the competence to serve the needs of your target patient population whatever that is whether it's pediatric or geriatric or cosmetic or orthodontic your practice has a certain look to it population wise your clinical armamentarium needs to provide the majority of their demands and needs in order to satisfy them the value that they look for in your practice has to be reflected in your clinical skills.

Howard: So I'm here in Phoenix Arizona so mesas gota dental school glendale's got a dental school two dental schools dumping out almost 200 dentists a year there private school so I know the national average student loan debt it's about two hundred eighty-five thousand dollars but it seems like everybody I meet out here you know they're graduating four hundred thousand dollars in debt so you just mentioned CERAC so when they come out of school their first question is if I buy a CEREC machine a CAD cam and a new bio lace laser I just doubled my student loan debt do I have to double do I have to buy three hundred thousand dollar pieces of the equipment to be as successful as Matthew Krieger?

Matt: I'm gonna answer that question in two ways the answer the first answer is yes but the the stipulation or the second answer is I don't know that you have to do it necessarily right now. I think if you look at the totality of your practice and if you want to be competitive in a highly technical marketplace then I think yes technology incorporation into a dental practice is not a if or a maybe anymore it's a necessity. Do you need to do it the day you graduate dental school I don't think so but should it be sort of on your your business plan absolutely and should you look at it the same way as you look at the debt of dental school I don't know that I would. Dental school debt I think has less of a certainty in return on investment immediate dollars then does say a cone beam where I can now diagnose more procedures to do in my office. Everybody who graduates dental school has sort of the same degree maybe someone is more competent than another but everyone's a DDS or a DMD, if I want to do an extraction or an implant and the standard of care whether it be sort of assumed or or written is a cone beam and I don't have that maybe I can't do that procedure if a lab bill for a crown is $200 and CERAC or E4d or whatever it is allows me to do that crown at a lower cost which is more efficient and gets my patients in and out faster does that grow my business quicker so no I don't think the answer to your question is as easy as yes no I believe that through the course of a career certainly for a younger dentist those things are a necessity I am certain and I have clients who have none of those things that have successful practices I think it's becoming I mean maybe you agree or disagree with me I think it's becoming harder and harder to not have that technology and compete, what do you think what do you think?

Howard: Well the one thing that drives me the craziest is when people say the United States of America because there's no such thing I mean you can't compare Alaska to New Jersey you can't compare Wichita Kansas to Sarasota Florida even the Federal Reserve says there's nine economic economy...

Matt: Yeah I think yeah for the average suburban practice throughout the country where people you know if you pick the ten biggest cities where people are pressed for time where they have you know multiple children and they're running around where their needs are general restorative and implant dentistry I think that technology is an important component of and can only help if incorporated appropriately can only help a practice grow there are absolutely places where you probably don't need it and absolutely places where the option to practice without it doesn't exist but CAD cam cone beam 3d technology to me you know twenty years into its maturation certainly CAD cams in around 20 years more they're no longer kind of bells and whistles and dentistry like an MRI machine and medicine is not super cool new technology I mean we need one you have to have it if you don't have it you have to refer someone to get it. I think your question about the debt and student loans and students coming out was really when do I have to incur this debt.

Howard: Well you know I could do every show every day with someone coming on the show who's an expert in CERAC cad/cam CBT lasers but I firmly believe that the number one return on investment is consulting I mean every one...

Matt: I agree

Howard: Every one of my friends that collects two to four million dollars a year if they didn't have one consultant they had a different one every five years for their whole thirty years I mean my god I and I opened up an 87 I had Sally McKenzie in my office within six months and that was just the beginning on and on and on, so I think the so what I wanted to ask you the reason I brought you on the show is I'm really impressed with what you're doing if you go to his website I don't know what, what are my homies gonna find on million dollar PPO calm and talked about your journey how did you graduate from Rutgers in 98 and now you have a website where did this all come from?

Matt: You know I it came from a failed business attempt at putting on CE, it's a long story but I expanded my practice and built a classroom a lecture hall small one at that in 2007 not a great time and my grand plan was I was gonna pay guys like you to lecture in my facility and charge dentists you know a ticket to show up and your your name and and their ticket combined with a couple of sandwiches would make me a passive income of course the industry changed dramatically CE became significantly less expensive and certainly non-clinical CE became almost free you know because of the big three Cheyne Patterson and BenCo sort of giving it away to sell stuff I found myself with a classroom and no one to fill it so friend of mine who was in the industry invited a couple of his dental customers to come in to do like a roundtable discussion I led the roundtable I talked too much so I led the roundtable I mean I'm gonna monopolized all the time in the roundtable by lecturing not intentionally but and and the conversation was how is it that you take all this insurance you don't work all that much and you seem happy and you make all this money meaning relative to collection you make a high profit, what are the secrets you know and I answered them honestly this is what we do and this is how we do it and this is why we do it and these are the policies and processes and operations this is what we do clinically and this is what we do manage you really and this is how we bring in new people and so forth so on and all of them had the same sort of response which is can you come to my office and teach me this and of course I thought well no I don't do that I had a friend who was in the consulting sphere who came to me and said you know people are asking you to come teach this why don't you do it and so yeah.

Howard: Are you talking about Jason Siruchek?

Matt: Yeah Jason Siruchek who's not with million dollar PPO anymore but Jason and I started the company served together Jay has moved on to do some other amazing things in dentistry but he suggestion was why don't we do this and we did we partnered with Henry Schein early on and they refer to some business and we snooze some local people and and you know we had some dentists reach out and all of a sudden I found myself sort of on the national lecture circuit and speaking at a GED and a DA and doing all this fun stuff you know you and I have crossed paths people heard about the idea that there's this guy out there who's saying different things and everyone else primarily don't that you can take insurance and it's okay and you can make money and and I hated the feeling that I got having dentists look down their nose at me because they were fee for service and I was one of those PPO guys I had a nicer car than them and I made more money than they did but they sort of looked at me with this disdain like fee for service was the gold standard.

Howard: Right right

Matt: and I just didn't see it that way.

Howard: Yeah I mean I was that was my first taste of Panley I let him know what I mean the first the first day I canceled week I go down there or when Becker starts to dill and his first lecture is the a patient to be patient to see patient D patient he explains them all and says how you don't want any of the D or the C years or whatever and say you just you just described my entire pedigree I'm from Parsons, Kansas where word we're CDF people and they need a dentist to and I remember one time I got chewed out in oral surgery by Brett Ferguson and Charlie White to the greatest oral surgeons ever there's they're still ruling down there in Kansas City and I was asking this patient about the bar fight that not got us to then he said hey hey it doesn't matter doesn't matter if he's a jerk that started the fight or receipt it does it does it he still needs a doctor and I can't be his best oral surgeon if I know he's the bad guy and deserve to get his teeth knocked out this is you know if he needs a you know that that's not your place your places every single person needs a dentist this guy's in here right now and he needs dentistry doesn't need your 20 questions about what happened and at 1:30 in the morning. So again I tell these guys they love to learn about bonding agency love they love all that stuff but they but they tell you it on dentaltown if you just said okay what are all the stressful plane bitching and moaning threads all about it well it has to do with people it's either their patients or their staff and and you know how they leave their staff after the root canal they run back to their private office and shut the door and they're in there by themselves alone they don't want to deal with staff. I always tell them you know successful people are the ones willing to have the most uncomfortable conversations and I you I can't believe how many interviews I've sat with dentists trying to interview a new office manager and he sits there for the whole hour talking about himself his practices businesses vision and it's like dude you're selling yourself she's looking for a job and you're you want you're trying to sell her to take your money so how do you how do you get some man who would rather look at the periodic table than his staff and be a team and a leader?

Matt: I wish the answer was so easy well first of all I think that in order for dentists to to decide to get help the pain of their practice has to be economic so based on that so how they come to a consultant like you or I or anyone else out there is rarely you know I want to be better at business management or a better leader it's there's some crap broken in my practice and it's costing me money I don't have enough money I need more money I'm worried about money money money money some kind of money that is the symptom that brings them to the proverbial office my hope is that through implementation of some basic business systems that that they can connect to those some immediate improvement in economics of their practice that sort of opens their mind to the capability or possibility that there's more here to gain. So I go for the low-hanging fruit like every other consultant does and hopefully for a percentage of clients that low-hanging fruit opens their eyes to the possibility of higher hanging fruit because you and I both know Howard there's only so much low-hanging fruit. Every consultant who comes into an office starts with the obvious stuff that's broken that can have some immediate return and believe you me and you know this offices are super broken and there's lots of low-hanging fruit in most of them. Those clients that become super successful the Howard furans of the world use the low-hanging fruit and see hey wow what about the mid hanging fruit and the high hanging fruit and the mid and high hanging fruit are just like you said leadership better management the more right brain emotionally iq driven components to being a good business owner that's what we try and do a lot of dentists are not ready it takes like you said a multiple consultant visits and multiple you know attempts at having consultants some will never be ready they believe wholeheartedly that this is all about clinical dentistry and if they could just do a good crown the money should flow, some are just really out of their element but the vast majority I think if they can see some small improvements based on what we at million dollar ppo do with them operationally or efficient wise then I think that they become way more open to change and through our coaching I think those that can become self-aware realize that how they behave contributes to either the success or the failure of the business whether it's clinically how they behave or managerially or as the leader of the practice leadership and management or the hardest stuff to teach they are teachable by the way but they are the hardest stuff to teach.

Howard: Humans are guaranteed the most complex thing in the solar system I mean maybe the universe may be there somewhere but it is a very complicated animal to learn and even the ones you know the most like your my five sisters my brother, my four boys my five, you think you know someone so well but they're complicated animals and systems is a trigger were trigger ward some people think that you know they're gonna go in if you had all these systems it all would work like a Swiss clock and you know all the trains run on time and other people think no it's a you have people problems what's more important people's systems? I cringes systems because the number one selling software is dendrix it doesn't even hook up to QuickBooks Online you know they always and now it's part of Henry Schein one and they're always talking about all their dental portfolios of all these high tech companies and I'm an operation to logistics I believe it or not when I tell people you know in my lifetime Walgreens and Walmart both grew thirty thousand percent well everyone who Sam Walton was well who's the CEO behind Walmart's are Walgreens thirty thousand percent growth in my lifetime no one could pick him out of a police lineup because he's an operator like me sitting in the desk crunch of the numbers get getting it done and dentistry doesn't have any system when people tell me they like dentrix it's kind of like okay the discussions over you're you're not elevated enough to even know what the hell's wrong with your office I mean you can't tell me how many people called your office last month and went to voicemail you can't tell me your return on assets your return I mean I mean when when when dentrix doesn't hook up with QuickBooks Online I mean so to me systems is a trigger word to just saying I'm still upset that when I was 10 years old and my dad bought his first sonic drive-in franchising the cash register made by oh got bought by what was it called cash for was bought later by IBM but that cash register we're just a roll of tape had more business analysis at the end of a day at sonic drive-in then I have right now and I'm had an office for 32 years I'm 57. So how do you what what type of systems do you like and can can you save your practice my systems when your parent father Henry shines dendrix doesn't even think it's important to hook up with accounting but when you listen to Stan Bergman on a call or on squawk box talking to Wall Street funny how he knows all of his numbers his price earnings as earnings per share he knows all of his numbers I'm just sitting there like Stan can can you give us any of those numbers for our dental office from your genius dendrix that doesn't even hook up to accounting ok that's my rant I'll shut up.

Matt: Well I now know where you stand on Dentrix, for me systems are not necessarily about the software that you've chosen and I say that with the understanding for most of my office's that they don't use 90% of any of the software that they have effectively no matter how good the software is do I think systems are the end-all be-all of the success of a practice no for me and I mean I would suggest any consultant listening in most of the offices that I go into operate haphazardly from the moment that they key into the front door to the moment that they leave there is no protocol process understanding of or you know reproducible mechanism by which they get through their day it's either raw talent of a couple of team members that kind of muscle through or is short of willy-nilly you know kind of poke and hope half-assed operations

Howard: Poinking hope was that in a Bruce Springsteen or Bon Jovi song I know you're from New Jersey?

Matt: No it definitely was not it was probably a little bit more sorted of a thing than that but so I think systems to the system lists are important I think John quois maybe said you know and I don't know if it was him who was paraphrasing but he says he said or someone said people don't run businesses systems run businesses but people run systems so I believe in both I think you have to have well-trained people I think you need technology I think your technology needs support the business whether that's dentrix or something else but I think you also need to have good operations I think you need to have it all I think the idea that you have one broken element to your business is foolish I think a business is balance there are things that you do real well there are things that you don't do at all and there's the gamut in between I think there's work to be done at different scales to all of them almost every practice that we go into shows up with a chief complaint, Matt I was on your website I spoke to so-and-so they worked with you here's what's wrong with my practice my hygienist blah blah blah and I don't know how to collect money and if you can fix those two things I'll be a billionair. You know months later as we work with them Howard what we find out is yes those are the things that they recognized as being problems but there's 50 other issues all tied together that need to be addressed in order for them to have the success that they believe that they can have. I believe in systems I also believe however that the classic fee-for-service laziness that is dentistry has at its core a misunderstanding of what systems are applicable to the people who buy dentistry in 2020. So I approached the dental business as a retail sales and service business that operates on a manufacturing platform and to that end the systems and policies and procedures and training and team building and leadership that I encourage are all built around understanding that most dental patients are really retail buyers they are not health care buyers they are not there to save their life or to have a baby with unlimited budget and unlimited time and and the unlimited willingness to do what it is that you say. They are there for a transactional experience I want to buy ex a cleaning I want to buy Y a tooth that I lost in a bar fight and the dollars that I have to spend on that X or Y are minimal and in direct competition with Apple and Uggs boots and Nike shoes and you know browning weaponry and Chevy trucks and health care does not share that same issue, when your child is sick with disease you do everything in your power regardless of what is reasonable to fix them there is no budget for curing your cancer you do what you need to do in dentistry there is a budget for $12 fluoride and if your patient just happened to come from Applebee's and get you know new sneakers that fluoride may not be in the budget in medicine you'd never hear a cardiologist have a financial discussion with the patient then nobody signs up for Care Credit in the chemotherapy ward it's just not how it happens people show up and they say I'm sick and if you can fix me and save my life whatever it is I'll take a year off work I'll go to the Mayo Clinic I'll bring my kid all over the country I'll do whatever I have to do I'll move and in dentistry it's hard to sell somebody a DO filling because they have to get to soccer practice in 15 minutes. Knowing that is very very upsetting to dentists because they have this need as you said early on maybe to to prove themselves or an ego I don't have that anymore I used to but I'd rather have you know a retirement account and and money in the bank in a nice car than an ego I don't have to to say oh I'm a doctor I know what my patients think of me I'm a dentist I'm a nice guy and their tooth is broken and I can fix it they definitely don't look at me the same way they look at their internist or cardiologist and I'm sure there are guys on here who are gonna disagree with me and i'm sure there are guys on listening into the podcast that holistic medical practices and take blood pressures and talk about systemic disease with all of their patients my patients want to clean it and they want to get back to work and they want to buy it at a reasonable price and they want to be able to eat into and be happy and so we build systems around what our patients want not what we believe they want but rather what they tell us they want and by overwhelmingly and we've obviously done a lot of studies with our own patients what my patients tell me they want is they want dentistry t fast they want to be here as little as humanly possible they want to have transparency around what their financial obligations are without any kind of surprises in the mail they want to feel like they can trust that I'm gonna stand behind my work so long as they sort of behave themselves and they want to feel like this is a place that they can come to regardless of their own internal philosophies about the value of dental treatment. So they don't think teeth are important I don't shun them from coming here I welcome them to my office because what's important to me ideally is what's important to them.

Howard: So at the end of World War two Japan was Japan and Germany were destroyed in fact both countries did not officially say the rebuilding was over until 1980 which was when I graduated my school I still couldn't believe when I graduate high school's like I was learning about World War two in history class and now the president just said they finally rebuilt I mean it was crazy but the hero that went into Japan was W Edwards Deming and and he is their guru god from America he and they when you go lecture over in Japan I mean they just I mean he's their business guru and he says a bad system will beat a good person every time 94% of all failures as a result of this not people and manager people need to understand that all people are different he needs to understand that the performance of anyone is governed largely by the system that he works in the responsibilities of management if you can't describe what you are doing as a process you don't know what you're doing W Edwards Deming the book total quality management. Deming was a manufacturing guide you how much of that do you think applies to a service guy like dentistry instead of making cars and motorcycles we're fixing teeth do you think that's an easy translation back and forth?

Matt: Yes I do because we're we're like I said we're retail sales and service but we manufacture the goods that we sell in service. So I look at a dental office like a car a car dealership that makes its own cars so when and even when we talk about dentistry Howard what word do dentists your clients your listeners used to describe their day they say my production today was really good that's a manufacturing term production when you show up with that missing front tooth we're gonna provide treatment for you yes and part of that treatment is we're gonna manufacture it too, weather the laboratory weather we're gonna farm it out or whether we vertically integrated and we're gonna manufacture it on-site whether that's gonna be done in the drop mail setting meaning we're gonna do it today and get it to you right away or whether we're gonna do it over you know two weeks or a year or six months but ultimately almost everything we do outside of some basic maintenance hygiene maybe some periodontal scale and root planing there is a manufactured deliverable a filling a crown a bridge a denture. So yeah I think manufacturing principles and certainly lean manufacturing principles are entirely applicable in the dental office and that's where where my fees which are 40 30 40 percent less than fee-for-service fees can still be way more profitable then fee for service fees in most offices because the waste the toyota transformation came not in raising their prices and increasing their fees actually they lower their prices a little bit it really came in more systemized manufacturing of the goods that they sold so that their price would be commensurate with a larger audience there were more people who could buy those cars if they could keep the price lower and so if they became lean and how they made those cars and I don't just mean lean in materials but also in in human capital in systems and policies I mean they kind of mastered lean manufacturing then they could sell a product at a high profit margin and you and I both know and maybe you're listening know if you look at Toyota I mean it didn't take very long for them to become the most profitable car manufacturing company in the world beating Ford Chevy and GM who had had you know how many years of a head start on them 50 and it was all because one company was what much more practical and lean about how they manufactured and the other wasn't and dentists and certainly fee-for-service dentistry Howard breeds inefficiency and laziness because at its core the only system you need for success in it in a in an old classic fee-for-service practice the only system you need was how to raise your price you could be as wasteful as you wanted you could be as haphazard as you wanted into the 70s and the 80s and if your cost your cost of goods sold went up you could maintain your profit margin simply by raising your fee and for many many years you probably were part of some of the earlier ones your practice would be successful because people would pay your fee there was less competition though there was less bee awareness there wasn't an Internet there wasn't corporate dentistry but nowadays you and I both know raising your fee is not so easy people know how much a crown costs because they can google it right now as they're listening they know exactly how much every dentist within a hundred miles of them charges or X and they know what is reasonable and what is to be expected I think manufacturing processes are super applicable we teach a lot of them.

Howard: Rrue, fear and greed are the every business operates under fear and greed prey and predator I mean you you can't go meet any dentists and talk to him for five minutes without him thinking and the sky is falling and it's all gonna be from dsos. Do you, I just lectured the DSO has just had a big convention out here in Scott sellable a couple weekends ago and I went out and lectured to probably a hundred of some of the biggest DSO cats in the industry they all they love Arizona because Arizona started with licensures my credential like ten or fifteen years ago and you can great you if you're a dentist anywhere in the United States all you gotta do is just tell the Arizona Board of Dental Examiners you got a licensed so that's why Arizona is 18% of the dentists are involved with the DSO where other states are not even were five states don't even have one percent so my question is do you think how does that individual compete with a DS, how do you can be compete with a dental office who has a layer of management just helping with marketing and HR and legal and websites and or do you think they can? I mean is it one of those things we're gonna have to join him to beat him or what would you tell a graduate if she came out of school today at twenty five open her own dental office and said I wanted I want to practice just like you from age 25 to 65 is that gonna happen?

Matt: I think for a percentage yes and for a percentage no I think depending on what someone's goals are I think DSOs represent the sky falling for some but also a tremendous opportunity for others when you graduated dental school the opportunity for you to get out and not buy yourself a job didn't exist there was nothing else but I'm gonna either buy a practice or start a practice now if you've mentioned a 25 year old young woman what if you're 25 and you're a young woman and you would like also to have a family and perhaps you don't want the stresses of owning your own company there is an outlet for you and you can work in a DSO and not have that that sort of burden so I think that's a benefit I think for others that's not necessary nor nor do they want to be involved. I think you can compete with and and actually outperform dsos from the standpoint that I don't think any DSO is going to have a dentist working for them that is going to care more about their practice the DSO practice then does a private practitioner who owns his own company an employee is never going to have that same level of feeling about their business than an owner and even the DSOs know this Howard as you know from lecturing to them so they're trying to create some level of equity or ownership for their their dentists but I would tell you that there are ways to be competitive and depending on what state you're in a lot of ways to be competitive. One of the primary ways is be smart enough to hire a consultant to help you understand how to manage the HR and your marketing and your team pay somebody like the DSOs do on staff to do those things for you. Dentists are afraid to lay out three grand a month or five grand a month or fifty thousand dollars for consulting but they'll buy a Waterlase for forty five thousand dollars on a whim at the meeting that they'll never use I have like an erbium YAG laser I used to hold my loops I mean every dentist you know including you and including me has the closet somewhere in their office filled with shit that they bought for a ridiculous amount of money that they never really used most people get more out of having an advisor than they do having a toy done it's like toys more than advisors but there are ways that you can build your business to I think be competitive. I also I find DSO to be kind of a duality I believe that there was some benefit to it I also believe it was created by dentists so the ability for DSOs to invade we look at it something that happened to us as a profession and I would say the we created an environment in which our businesses were so poorly run that that private equity and business investors saw an opportunity to buy them from us and and improve them so significantly that they couldn't turn their heads away from that easy money whose fault is that, is that their fault for for seeing an opportunity and exploiting it or is it our fault as a profession for allowing our businesses to become so grossly unprofitable that private equity came in. If you if you follow that thought process what if you make your business highly profitable and highly successful then it will be less appealing to the DSO they won't try and take you over or conversely maybe they'll offer you some ridiculous amount of money to have you work for them and buy your practice either way I think there's enough people with enough teeth who eat a lot of carbohydrates and don't brush or floss that there's room for all the different facets of private practice options DSO included. I think and I believe this my focus is on my practice and my economy and my backyard and not everything else going on in this sort of catastrophe er that dentists love to live in run a good business provide good services have good systems policies and procedures, be a place where people want to be, be a good person and I can't imagine you can't have a successful company and if you don't know how to do that hire somebody to tell you I can't give you better advice.

Howard: I'll tell you I'm to me it's interesting how many routine simple things we've known in economics for a century or two still has the income to dentistry like if you go into a dentaltown there's 50 forms and one of them is designing a practice and all these people have these questions like should I have 4ops 5ops 6ops and describe my floor plan here's my floor plan. 20 years of being on dental town every day for two decades no one's even mentioned like sales per square feet I mean just routine terms that everybody would think about do you see any retail and manufacturing principles that need to be applied to the business of dentistry?

Matt: Yeah so for me lean manufacturing a vertical integration a basic understanding of the economics of any business revenue revenue per customer revenue per square foot revenue per hour revenue per day value per procedure or lack of value per procedure all of those principles need be applied. I would tell you 50% of the dentists that I speak to in preparation for them becoming a client don't understand what I mean when I say to them what was your revenue last year, the word revenue throws them they sort of crimple their brows and say something like do you mean my collections I say yes business owners outside of dentistry say things like revenue or gross revenue or profitability I think dentists all should have some basic business course what do these words mean and what does something like vertical integration in my business being what is lean manufacturing and how can I apply it what do you mean when you say a system. I think dentists wanna buy systems I think they all call me and say I need systems I don't think they could define what a system is I really think it's to them an idea I don't think that they mean a written process and flow operationally through you know one task to the other I think the most basic of business principles have eluded us forever it's frightening and I'm not talking about unsuccessful dentists I'm talking about you know successful guys in their 50s with seven figure practices that if I say what was the revenue last year they would say something like you have to ask Judy my office manager she kind of runs that stuff and she's on vacation. To me that's just ludicrous I don't I can't even imagine what if she doesn't come back from vacation.

Howard: Yeah it's crazy so if my homies went to your website they're driving in a car this is an easy wonder I always try to get them anomic device it's million dollar PPO well if they go to million dollar PPO what are they gonna find?

Matt: They'll find information about our company and how we work with clients to grow their businesses. Most importantly I would encourage that they'll find a way to communicate with myself or one of my team members one-on-one via cell phone about their business because you and I both know dentists want to talk about their practices and they want to share their problems and they want to explain the nuances of what's going on that's different in their business than anyone else is of course we know that's not the case so that's what I would say they would find I'd say they'd find an opportunity to grow their business whether they're a PPO practice or a fee-for-service practice they would find a very fresh perspective on what dental practices look like and what the future of dentistry is like and how to run I think a more practical business. Dentistry is a very basic practical business your patients have stuff broken in their mouths and they want to buy solutions from you to their problems how do you move someone from the parking lot to the waiting room to the treatment room to the front desk and back out, how do you do it and make as much profit while being as happy and stress-free as possible how do you keep people on staff and how do you get out is it retirement transition sales. I think they'll find that on million-dollar PPO and a picture of me, I'm handsome.

Howard: You are a handsome devil. So when I go to your services you have the Maximizer the JumpStart PPO fee negotiation services web and digital development HR manual job descriptions great personality assessment start with the top two the Maximizer or the JumpStart who is listening to you right now that says yeah I need the Maximizer versus who's listening to you right now and says no I need the JumpStart and what's the difference in the Maximizer the JumpStart?

Matt: Well you know the Maximizer is comprehensive it's sort of soup-to-nuts everything you need in your business it's a it's a monthly program on retainer working with coaches in your office and the JumpStart is sort of phase one or step one of that it's a launch into the consulting for a whether it be for a new business or for an existing business it's a dip in the water so to speak versus the Maximizer sort of jumping into the deep end.

Howard: and how much is that?

Matt: Fee's, there are fees quoted on the website but I'll say on the podcast fees vary from client to client the best way to get a fee for our product is to call us our average monthly fees for comprehensive coaching range from mid twenty five hundred dollars a month to as much as ten thousand dollars a month depending on how big your practices and how many locations you have and everybody every practice that comes to us has a different starting point in a different need so we customize our fees whether it be the jump start or maximize.

Howard: and what is is it a contract as they like sign up for a year or?

Matt: No, yeah we go month to month because we want skin in the game and people panic about contracts and I don't understand the idea that I'm gonna hire an advisor and guarantee that I'm gonna work with them for a year it to me is like what if you don't like each other after six months so we have to stay in this marriage together we have no opportunities we have to fight to get out of it. I want you to be happy working with us.

Howard: Yeah I tell them to at least sign a contract with a woman if there's a child involved there's not a child involved just a month a month retainer fee it's no but...

Matt: Yeah we're we're a month-to-month retainer as an on demand so if you said to me Howard Matt I want you to come out to my practice I want you to spend two days with my team and work on case presentation or I want you to come out and help us you know work better with CAD CAM or get our financial arrangements what I would do is quote you a fee for whether it's me or one of my co just to come out based on your needs and where you are and what you would need, how big your team is and you pay me and I'd show up and I would handle it and if you wanted more after that you'd contact me if not there's no ongoing contracts. We're not trying to tie anybody up I think it's ridiculous.

Howard: Yeah and the other thing I see all the time is like not only do they want a year contract but they want the whole 50 thousand for the year and the dozen at so now they're financing with interest this contract for a year and I'm like well how do you finance the service haven't got yet the same thing was with an ortho it's like you only incur the cost of the ortho patient when they come in and get their retainer checked or their their bands check so why do you need the whole $6,500 upfront or the case is 24 months are you gonna prepay your rent are you gonna prepay your staff are you gonna I mean you got $100 for the brackets and everybody and says in economics is get rid of your economic barrier to entry and you just told mom that her daughter can't have braces unless you comes up with $1,500 then you're gonna finance the back half for a year and that's why when orthodontic centers of america went public back in the back in the day they just said look we're not financing this it's like it's like why would you finance getting your nails done if you're gonna get your hair and nails done every month for two years do you need a 1/3 down for a two-year contract. I mean we only incur cost and I know you shouldn't take advice about getting your hair done from two bald guys on a podcast but the bottom line is I it's a huge red flag when people need long commitments and financing things that they'll have no cost incurred for time to come but I want you to go to million dollar PPO, I'm telling you this is a consulting guy that has more to do with the majority of America than the lifestyles of the rich and famous in Key Biscayne in Manhattan and like Scottsdale. Like you know why Aspen is kicking butt in Arizona because every dentist that comes out here wants to go to North Scottsdale where all the Richie Rich people lives and Bob Fontana's CEOs and other and tell me oh my god there's like nobody in Maricopa there's nobody on the West side he goes you know why we're kicking butt because we go where they ain't. All the dentists are chasing the rich and we realize everybody needs a dentist and on that note I gotta go. Thank you so much for coming on the show today it was an honor to podcast you and I hope you teach these dentists that they can make money treating the middle class.

Matt: Any time Howard, it was a pleasure being on thanks for having me was fun.

Howard: Aright thanks buddy have a great day. 


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