Dentistry Uncensored with Howard Farran

How to perform dentistry faster, easier, higher in quality and lower in cost. Subscribe to the podcast: https://podcasts.apple.com/us/podcast/dentistry-uncensored-with-howard-farran/id916907356

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Well, it is New Year's Eve, and I am so honored to be sitting in the podcast studio with a great friend and legend of mine for 30 years, Dr. Curt Hireman, and his son-in-law, who's also a dentist from the same dental school, Dan Durant. Thank you guys so much for coming in here and helping everybody to start 2020 off with better vision right 2020 vision so so Curt we've known each other forever you're talented in so many ways I mean you're you're the best musician I've ever met in dentistry I mean I don't know a better musician and we were always taught in school that the mind of mathematics and the mind of music is in the same area and place and all that kind of stuff but aside from that you you have five offices yes you you've been crushing it forever.

And these are such changing times as dentistry has gone from a cottage industry where nobody owns 1% of the locations that we still have today in wheat and cattle and corn and milo and all that stuff, and it's it's slowly consolidating. And DSOs have probably taken about you know maybe 18% of the market, you know they're gonna be coming up on 20%. And we're in Arizona which has a penetration at 18 and a half percent. In fact, there's five states on the other end of the bell curve, they don't even have 1%, and Arizona is at 18 and a half percent. But you have five offices, so that is a DSO. You know when people talk about DSOs they always want to talk about Heartland who just passed a thousand locations or Bob Fontana who just passed 800, but the average DSO is like three to five locations, that's you.

Yes. So talk us on your journey, you got out of school we both got out of school in the late 80s, you 85 me 87. How long out of the gate before you started thinking I'm gonna have more than one location? Yeah so I mean I graduated in 85 and was an associate like everybody else you know and right out of the gate though I was looking I wanted to have my own business and you know I was kind of geared that way. So I started looking for a dental office but I had no idea what I was looking for so I ran into all kinds of all kinds of things that would happen

there finally you know another dentist in my neighborhood I was I sent out letters that was my thing into the dentist in the neighborhood and one guy responded said you know I'm sick I need somebody to take over my practice so I you know in a course of an afternoon I sat down with his son and we pounded out a little agreement. And I was off to the races in 1988 or 1989 with my first, you know, dental office. And so, I'd been an associate just down the street, and we didn't have a covenant or anything. So, once I had all these people in my office, I bought a pretty big practice, and then had all my patients. So, I was like, 'Uh oh what?

Oh,' and then I said, 'Maybe time to get my first associate.' That was right around the same time you were putting out a brand brilliant piece of work, the business of dentistry, in cassette form. And, uh, because that was explained to me, I'm not that young, but you put that out, and I used to listen to that all the time in my car. It's like now this is the media now, right? Podcasts. I listen to cassettes and, um, you know, I started using some of your ideas, okay, and, uh, got my First, associate okay, so what are all the associates' most, all the associates. The associates come in and say, 'Well, I'm here until I find my own office, you know.

I'm thinking, well, okay that's this is gonna get old in a hurry if I have to keep replacing you guys every year. Uh, so I said hmm, I'm gonna come up with an idea. Uh, the idea is gonna be uh, I'm gonna set the price, you're gonna buy this office in five years, you're gonna pay x dollars, okay? So before we even get started because what was, so many deals fell apart because the dentist went in and said gee, you know, let's see how things go. And I didn't want to do that, so I set up a price and at the end of the time, they bought the practice, so that was the first one I did, number one, just like that. It worked out great, I think.

The woman dentist; she was in there two or three years, and then I did it again and again and again, um, a whole bunch of times, um. But that that was my original format after having some associates just kind of come and go, you know, what do you call it, the rotation of associates coming and going. They weren't staying long, our generation, so you're so, your first associate, so you realized that the associates didn't have skin in the game, right? And um, you know if I have to explain the importance of uh, of having skin in the game, and if you don't believe that a dentist with skin in the game acts differently than someone who doesn't have skin in the game, then we have to throw out all of economics, right?

Everything since Adam Smith; we just have to say oh, he was a crazy old guy. So you realize that the employee dentist did not have skin in the game and was going to be a turnover. So how many turnovers did you have before you started offering skin in the game? A couple, a couple, yeah, a couple, and then, and then that, and then maybe after the second one in a six-month period or so I said, well this is gonna, you know, let's, let's come up with a better plan. So, the maybe the third associate I said, let's get skin, let's get you skin in the game. So you're at five locations? Yeah. So are so you have partners in all five of those?

I have no right now; I've had the whole gamut of things, partners, associates, but now I'm just me. Okay, so so now so you've reversed course or course um so um you you get out of school yeah you it takes you about three or four years to own your own office um which is um still kind of what we see today and um and then you had a couple of associates and you went to partners. Yeah. And, uh, I assume as you get older, you get wiser through trial and error, you know. You can only stick your tongue in a light socket so many times on the I mean, in fact, I was teasing my oldest sister, who's a nun, over Christmas because I never...

whenever she talks about her childhood house, I always say, 'Do you remember when you told me to put my tongue on that nail in the wall?' I mean, just literally knocked me down and uh, shock and uh, she's laughed so hard she cried. But um, but now um, you're back to people without skin of the game in five locations, yeah. So how did you get from A to B from skin to so from no skin to skin? Was it the revolving door of associates I wanted, I didn't want them, you know. I was afraid they're just going to come and go so that got skin so they did that you know like five times you know and then I went the partner route which as you know is uh that works what zero point zero percent of the time I don't know I've I've never

I've never had a partner in dentistry yeah you know it's hard because unless you're doing something different you guys you're in the same thing doing the same work competing for the same dollars and uh I don't see it working very often so I tried it a couple I tried a couple guys I thought we're good guys and didn't work out so but but you were already a but you tried it so he's a partner yeah he was a partner so how I had To buy him back out, but was that just a smooth deal? I'm gonna buy you back out or was that like a divorce? Yeah, yeah. And when did you get a divorce? Yeah, I got a divorce. I got a divorce, I got a divorce...

When uh, you divorce in a personal life, you know, I, you're not going to go nuclear because you got children. I mean, I when I got divorced, they handed me the deal and I just signed it. I mean, I wouldn't, you know, go to war with the mother of my four children. But I know a lot of dentists who said their divorce with their dentist partner was 10 times worse than their personal family divorce. Did you find it was bad? Yeah, yeah, yeah... No doubt, I-I-I know I just talked to a guy over Christmas and he was like, 'I don't know his name Thomas,' and um the the partner bought in for $500,000 after two years, it didn't work out; he spent $600,000 on legal fees to pay him $500,000 back.

I've been there and it's like, 'Did you hear the math on that? That is not pretty.' Yeah, well that's kind of what I thought when we talked about what I'm thinking to myself: What can I talk about with Howard? I mean, we could sit here for three days and talk. I mean, so we got to kind of but I thought if I tell a few stories maybe some of your younger guys will think, 'Yeah, maybe I shouldn't do that' or it might give them yeah, yeah let's do that, but Um, uh, yeah, you, you want to start, you want to do that first, we're doing it already, yeah, well I'm just so um, so

how does so not having skin in the game, having dentists that are employees, that's got pros and cons, yep, marrying a dentist, so you don't live with, sleep with, have children with no social glues with um, that is um, that is uh crazy, okay, but let's stop on that one because your young guys will say you know I got my good buddy from dental school and we're such good pals and all that you know, then it's real easy, is, he great and bad are you sleeping with this guy right? All right, you want to have babies and dogs and kitties, yeah, furry friends. Yeah, otherwise after a year you're you're both thinking, 'We're fighting

over the same patients, you know?' Or, 'You know', and so and one wants to get a uh serac machine, so one guy's like, 'Okay, we're gonna get 150,000 Serac machine and fly out and do training non-stop forever.' So that Ellen, my assistant, who's never made a crown can start making crowns, and the other guy's like, 'Dude, I got a lab guy one mile down the street who's 60 years old; he's made 30,000 crowns right for a hundred bucks', and and then it's CBCT, and then he doesn't want to take this insurance, and you want to take an PPO, and unlike your spouse you're in each other's face that's right eight hours a day so you've already coached

your i love your homies you call them um i love that you've coached them against that i you know i i think i think marriage is great just make sure she's really hot and you like sleeping with her and you make a bunch of babies and married to my daughter yeah but but but those are the social glues that keep the unit together because so many times um you know um world politics and family politics is the same you just make decisions on what's best for the baby where so many people are like i don't know i don't know i don't know i don't know i don't know countries their decision making is based

on revenge of other tribes adults where their babies are caught in the crossfire if you only make decisions based on your babies are for us now grandchildren and um so um yeah so you know partnerships work when you have a common goal which is the children and the grandchildren the great grandchildren but when you both know mike abernethy and his whole spiel on partners listen to that and how it's all worked out and all that for him and that's really what kind of got me into it thinking you know okay this partner thing might work based upon the way he presents it you know and selling Things off and buying parts, but you I don't know. It's a tough nut to crack. Is uh sapiens are a challenging animal.

I mean it is a um it's not like a little Labrador retriever or gerbil. I mean it is a complicated animal. And uh so yes they do work. Yes they are nightmares. So um tread carefully. I mean uh you know, tread carefully. So that's what happened with my first. Basically in conclusion, you're saying the um dentist that you're not married to without skin in the game is a smaller set of problems than being married to dentists. It's this right? It's i agree, degree i agree. So now I'm in control. So now you have five locations. In Michigan and whenever I think of Michigan, um, I mean, that used to be a city. What was the population when you got out of school? I mean, it was over a million or more when you got out of school.

Yeah. And you've been growing while that city is there. Is there any city in America that size that shrunk and contracted more than Detroit? I doubt it. I mean, it went from maybe 2 million. It might have been at 2 million in the, what, 50s, 60s? Yeah. And then it's down now to, what, 500, 600,000? Yeah, it was 1.85 million in 1950, and now it's down to 713,000. That's a pretty good guess on my part. So how do you go from one location to five while you're- I mean, I just have five right now, and I'm always moving, getting more, getting less. And that's what keeps the deal alive to me. Because when you just lock into one thing, I think it's a little bit of a problem.

That's why with the first associate, it worked out so well. She knew she was going to buy. She knew she was going to buy at a certain time. So her four years of hanging with me, we knew what was going to happen at the end. When I've done it other ways, guys come in, they leave for no reason. The hardest thing now is getting, finding good associates. Yeah. I mean, it's just- and that's it's funny because the dentists are all complaining about the cycle now, is expansion of dental school. Like when I got out of, when you and I got out of school, the dental schools were contracting. They closed down Emory, Farley-Dixon, George Washington.

You know, they, they closed down about seven dental schools and then it flatlined and then like everything now it's expansion and the cycle from consolidation to deconsolidation from economic expansion and contraction, the whole business world sorts with cycles. So now the cycle is expanding and everybody's like, my God, we got too many dental schools. But you talk to anybody trying to hire a dentist, they're like, there's no dentist. Yeah. So, so it's kind of funny how the- The mainstream herd of older dentists thinks there's too many dental schools, but the guy on the street trying to hire a dentist, it's slim pickings, isn't it? It is. And as Dan would tell me, as he's gone through school, what they learned is depressing. I mean, they only did what, two crowns, one root canal, one denture.

I mean, the, the, the, you know, to get through school. So now, I mean, how many crowns did you have to do to graduate? I mean- My God. Well, I, we had five endodontists. Full-time in our school. And I know dental schools now that have one. And the class size is bigger. And my God, I, I used to stay during spring breaks and like the Christmas vacation. I mean, I would only drive back home to Wichita and see the folks for like one day because they had the pain chair open. And the two smartest oral surgeons I ever met in my life, Brett Ferguson and Charlie White, two board-certified oral surgeons. They're still manning their post. And my-My gosh, it was, you're in Kansas City, pain chair, extractions out galore, and my God, they would let you, you know, it's your patient, go for it.

And then, and then when you finally just couldn’t do it, one of those two would come over and remove the rest in like 0.8 nanoseconds. And so it was, the training was amazing, but now they can't even find patients. They're, they're trying to find patients for dental school, like the dental offices across the street. Yeah. On the same platform. And why is that? I mean, there’s more people, you know, like you just pointed out earlier, there's, you know, we’re at a 6 billion mark or wherever. I mean- We’re coming up on 8 billion. Yeah, 8 billion. So 1800 was 2 billion. So how come there’s- And two centuries later, we're at 8 billion. How come now they can't find patients in the dental school as to when we were there?

There's tons of patients. I don't, I don't get that. Yeah. So it's a, it's a real changing market. It's changing. Yeah. It's changing. Like you said earlier, it's hard on these young guys that come out. They got all this debt. You know, they haven't done a lot of procedures. The insurance companies, I know, you know, for us with Delta, they pay a different fee for, you know, the younger guys. But what, but what is your true business model? Because a lot of, a lot of young kids, how young are you? I'm 29. 29. My baby is 30. So, so a lot of times, like they'll look at McDonald's and they'll say, 'What's a business model?' And they'll say, 'Ah, Big Mac, frying a Coke.' Well, not really.

They go buy the land for say the best location possible. Say first street in Maine, they'll put up a 4,000 square foot box. So the land will be a half million. The box guts, another million, whatever that costs them. It'll be cheaper in a small rural town and it'll be really expensive in New York City. But whatever that costs, that's the franchise fee. So you come along and you buy the franchise fee. Now McDonald's owns land, building, and signs, and you're signed to a rent that costs you 12 and a half percent of collection. Okay. Okay. Okay. So McDonald's is a real estate company collecting rent each month on 40,000 locations. And secondary is this hamburger thing they do on the side. And a lot of dentists have done, you know, Rick Kirshner does that.

I mean, Rick Kirshner owns 300 dental offices that the first of every month they pay a fixed rent because you can't do a percentage rent in healthcare because it's illegal as fee splitting, which comes from the old days, which is very bad where every time you refer me a patient that needs a surgery, I kick you back. And so then a lot of people were getting surgeries. They didn't even, that's illegal. It should be, you know, as will be, but you've bought and sold a lot of offices. So do you, is your, so you have several revenue streams. There's the money you make from doing dentistry on your patients. There's the money you make from associates doing dentistry in your, in the dental office you own, but is buying and selling dental offices a significant part of your revenue stream?

I've had a couple of home runs, a couple that weren't, you know, you know, everything in between. You know, it can be. Would that be all three revenue streams that you use doing dentistry, associates dentistry, buying and selling a practice? Yeah, I don't have any other thing going on. And any, any lessons learned from why selling a couple of dental offices were home runs and a couple weren't? Yeah, it's all about the guy. I mean, or the girl. So, I mean, when the first one was what hooked me on it because it was, it just wasn't like clockwork at the so-and-so mark. She gave me a check for that. And the beauty was, you know, if she, and she, you know, she's a dentist. She did produce and collect way above where my price was.

So I was happy at the end of the deal because I set my price at what I thought was a good price. She was doing way over that and then paid less. So that was a, that was a home run. And that's what got me started on that whole thing. And a lot of people are like, well, what the heck? You know, I mean, I'm like, well, I think I am a little ADD like you. And the fact that, you know, I just can't sit in the dental office all day and he knows me, you know, I, I, I gotta have other projects going on. I thought. And I'm not gonna open a restaurant or, you know, do something like, I only know dentistry. I mean, really.

So that's what got me started with that. You know, I'm going to do multiple offices; how it took different channels were just people I ran across like Rick Kushner. You're talking about, I mean, he was a great, um, inspiration to me. You know, I, I knew him when he had 20 officers or five off. I mean, I knew him a long time ago, but he is inspired. He's he's lives right up the street from where you're staying. He does. Yeah. He's got a place up North in Scottsdale, Fountain Hills or Cape. Oh yeah. Yeah. Yeah. Yeah. He's, uh, he lives in Denver and it's hard to golf there in the winter sometime when I'm over here with, I'll be here a lot more with my son moving, but, um, we'll go get him sometime.

But yeah, he was, he was huge. I mean, I, I loved his model. I went to his lean and mean, I memorized all that stuff. And you know, that, that was kind of where my model was at that time was. So I see, I see Rick is, is, um, two separate issues. So he's got his mean and lean of how he is, um, comfort dentals run. So he's got his business like McDonald's has to all be paid. He's spiced sauce, cheese, lettuce, onion, sausage, bun, but then he's got the, the real estate model, which is really, really interesting. And I don't know if, uh, Rick Workman wants me saying this on a podcast or not, but Rick Workman owns a ton of dental office, real estate too.

He, he, um, so, um, the business model of the future obviously hasn't been evolved yet because it's constantly changing. So we don't know how to look in 10, 20, 30, 40 years, but we know it won't look like anything today because when you look back 5,000 years. Mm-hmm. Everything always changes. Yeah. Um, but, um, a huge component, uh, Kershner and, uh, Ray Kroc, who I got to meet Ray Kroc. Oh yeah. Because my dad was in the Sonic business. So when he went to the big hamburger conventions, he was the rock star. Yeah. And, um, the, um, it was a, uh, my dad was in Sonic drive-ins and I had to, uh, oh, it was so sad. I went home for Christmas.

So I wanted to call my buddy, Roger Carpenter, who had, you know, it was my, my dad had single digits, you know, like nine, he had like a hundred and, uh, passed away. Oh. But, um, but yeah, he, um, would get the land, get the building and then, um, um, that's a whole separate deal. So I know dentists that are routinely, they're, um, looking for like an old 2,000 square foot building. Maybe it was an old state farm building or you just, you didn't even notice it, but it's always on a four-lane road and it's already built. Cause when you buy raw land, you got to get an architecture permit, construction, all these things you don't know that, that aren't going to increase the value of what you have.

So when you have a used car. I mean, you drive it off the parking lot, you've already saved 10, 15%. So to buy an existing used building, um, and the real estate cycle is about a hundred years from brand new to a crack house getting bulldozed, it's, you know, it's a pretty predictable cycle. So when you get something, you know, and, um, in the middle of that cycle, you know, maybe 40 to 60 years old, and then they go in there and they renovate it and they, uh, turn the, uh, the grass out into a parking lot and cut the tree down and put six ops in there. And then they started a dental office and associate, but they're, but they've signed a lease, um, for, you know, 10 years.

And then when they finally, um, you know, so, so that was a big passion for me. I love the, I love designing offices. I took Scott Luna's course and, uh, that design was good, but I, even before that I've done six dental offices, either out of a box or my two superstar wild ones were in old houses made out of stone. Yeah. Where you got to drag all the plumbing through all the old and turn those into dental offices. And that's, that's been a great little, did it might, did I make me money? I don't know, but I love doing that. I mean, uh, It sounds like artistic, like your music. Yeah. Yeah. It's, but it's cool. It's painting and It's cool that, so like you got a big box and you just put, you did it from scratch.

I did a couple of those. Those were good. The big challenge is when you take an old, big old house and have to tweak everything to kind of, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, uh, now, now you, um, you're out here for Scottsdale and Christmas vacation. You got a place down on an island in Florida. Um, why did you stay in Detroit contracting as opposed to mobility? Well, I tried to go to Florida. I did go to Florida. I was in Florida quite a while, but it's really hard to be operating out of state like that.

And I ran into legal problems and all kinds of things with that. And so I came back because of licensure. Yeah. It's really a kind of a weird licensure, it's uh pretty much an old boy system but uh you know, in Arizona, um I gotta give them credit, they um, they um... You have an active license in any state for anything cutting hair, nails, teeth, architect, engineer, your license in another state, your license in Arizona. We're the first state to do that, and that's why it was. And, 18 percent of the dentists in Arizona work for DSOs because DSOs, oh, and some of those states, they they've uh redlined because the the good old boy clubs made so many obstacles, they don't even want to deal with them.

And so, the um, the dentists who want uh restraint of free trade, you know, they they got some good states to model after, but but Arizona is the opposite. So what was the good old boy club doing in Florida that made it hard to practice? Do do your model, yeah, I mean, what were the some of the details well, so I mean, so Coast Dental comes into Florida, heart, heartland Crest, I mean, a lot of big boys came in there, so I thought, well if they came in, you know, I could come In too, but it's really it's just taking your case to the judge and literally the judge just ruled on it. And in my case, he's like 'uh', no you're you're gone after my lawyer had checked it out that all these other guys came in and they were okay.

Come to find out later, he went back to the judge too. I mean yeah whatever, you know it was like when bleaching went to the UK. I mean all these bleaching companies like Dan Fish and Alternate spent a million dollars trying to get their courts to approve, yeah bleeding. And one guy, one old man for a year just said no, no, no, yeah, and that's it, it's over, yeah. So no, so then I went back to Michigan. I got a Michigan license, I'm comfortable there, you know. And how's Detroit now? Thirty years later from when you got out of school, so much different from like, I can when I got out of school, I still thought it was...

I still think of it as the day my first day in dental school down in Detroit where at the end of the day, I came out my car was on cinder blocks. I mean, I still you know think of Detroit that was your first day of school, first day at dental school, yeah, first day of dental school, your car was on cinder blocks. Come out and I'm like, 'Oh God, you know, Detroit's everything everybody's saying it's going to be a long four years down here but it's...' Gotten better, Detroit. But it's so long, it's gotten better, it's gotten so big, and there's so much that needs to improve that it's just... but your heart's still in it, you still live there, yeah, I still... and you, you were you born and raised there?

No, I was born and raised in Midland, Michigan, about two hours north of Detroit, and now we're working in Clarkston, a small town about 40 minutes north of Detroit, but so it's a suburb, Detroit, yeah, a suburb... So you and your wife were born in Michigan, so you guys want to stay in Michigan? Yeah, I like it there. Yeah, yeah. Winter's a little bit tough sometimes. And what is the main attraction just roots, family? yeah there i like the you know we complain about the winter and all that stuff but i like the four seasons and i think the cutest thing about michigan is um in arizona of course we have had a lot

of people retire from michigan yeah oh gosh and when you look at when you say they're from michigan you have to figure out are they from michigan or upper michigan because if you ever tell someone are you from michigan there no i'm from upper michigan oh excuse me i thought michigan was one of them two words yeah but yeah it's uh cute so so then what are some of these stories that you wanted to share with the so yeah so here you go right out of the bat to your young graduates what what should they do i mean they're you know most would what should i do should i you know should i get

a job work for heartland you know it's low stress right i mean you know uh should i find my buddy from dental school and like two of us team up should i so i my thought was just to tell you what happened to me i mean that was just i thought it was just a good idea i mean i think it's a good idea i think it's a good idea for what it's worth so that we did number one where a model is good if you want to bring in an associate so first off i think you have to decide what kind of dentist you are right i mean there's There's guys that are business guys, or I mean you and I are off that same kind of thing; we're business guys, we're dentists at the same time there.

But there's a lot of dentists who just want to be a dentist, don't talk to me about a profit-loss statement, you know, so and that's not going to change. You um, Harvard Business Review put out three papers this year because they keep about how millennials are different than baby boomers, but you know, talk to any biologist, you're talking to the same singular species Homo sapien. And as you go from the telephone to the telegraph, I mean, telegraph, telephone, internet, this guy didn't evolve. one bit, so um, Harvard Business Review just keeps finding that there's no statistical evidence to support all these claims about how you're so different uh than than me, and they. And they've been doing this for hundreds of years.

They every old generation thinks the kids are going to take the species off the cliff and ruin it forever, and then you find out three generations later, oh that that generation was exactly the same as the one before. So there's not going to be any hype of this so there is a new variable, it's gone from uh all male to half women right uh, so do you think that is a um do you think that will have any macro Changes in dentistry as it already has, yeah and what do you think those are? Oh, it's I mean female dentists don't work as long or as much. They definitely have a different work idea, you know. They think of themselves as caregivers, you know which we all are but that but I think the longevity and like the hours maybe as many hours maybe, okay so that that's that's um not his opinion, that's a fact.

But what is the cause of that fact? The effect, what causes their careers to be shorter? They have babies, um that I think, that I mean I think in dentistry, um I mean in general that's a big deal but in dentistry, I think that's a the secondary um issue to the fact that they always marry well a female dentist always marries a male dentist it's always somebody great with a job but you get that dentist and he'll marry the hottest waitress at the waffle house if she looks just right in a pair of levi's so they marry um they're they're not as ophthalmically challenged in picking a mate as the males are okay um

they uh they um they they just make better decisions on picking a partner and men uh i mean how many examples have you seen in your life where a man uh just made the craziest decision you know so so men are more ophthalmically so we're back to this thing of what what should women men do when they get out of down school and i still do think that you know having an associate position for a little while is good i mean yeah make your mistakes in someone else's yeah i'll never forget i started in 87 and it was about 97 it'd been like 10 years out i've been long enough out and i looked at their the sex train i thought myself what idiot did this

and then i turned to my assistants he goes you did that i remember the day you did it oh my god i'm just trying to comprehend how little comprehension i had a decade ago to do something that's stupid right you just don't know until yeah so so my gosh it's nice to I think it's good to start as an associate, I really do. And how long you should stay there? Well, not forever, though. I think that's the thing - you need to be thinking, you know. But it's going to depend on the person, and so in this bell distribution of uh your classmates, yeah um, what percent do you think um, like I have? You know, wear many hats?

They have a flair for business and marketing and they want a leadership and they want to own their own office versus oh hell no, I don't. I don't even like that. I just want to work for a corporation. I mean, I would say probably only maybe 10 to 20 percent really want to go out there. and kind of do this thing we're buying multiple offices and kind of own their own or even just one office or even one office only 10 so 90 want to stay the big barrier for us is the student loans are so ridiculous that it's hard for people to comprehend like okay i'll half a million dollars for dental school and now i'm going to take out another half million dollars to buy an office you know a lot of people are just scared by that so dan you've been out

um two years 2017 yeah two years so um what was your class size about 100 144 144 so is it the 80 20 is 20 percent working for themselves and 80 employees or after two years or is it a lot Less, yeah I mean I don't know many I can only think of maybe a handful that have bought an office by now. Most people are working for you know a bigger office and just kind of uh and are they mostly working for bigger chains like that have hundreds of locations or are they just kind of working for locations or mostly working as associate um in a single office location or an associate in a single office, yeah you know there's a mixed bag a bit but I'd say mostly yeah yeah.

Interesting, and and you um you, there's dentists in your family yes two, two yeah my uncle and then his wife my aunt, and what percent of your class was dentistry already? In their family, a pretty good chunk actually, a lot of people; their parents were dentists and yeah, I see it anywhere I go, it's always a quarter to a third of the dentist in any country; it's a family affair, really neat. And then you married into a family, yeah, that's a dentist. I i just think that's so uh, that's cool because everybody's more you know they say the biggest part of any problem is communication, so communication, communication, communication. So you knew about dentistry before you made the decision to go in, uh, your spouse grew up in dentistry, so you just, you just, it's like graduating with a college degree for your communication.

You know what I mean, just a long line of how it was funny they were asking me about you, why don't you know, and I said well I gotta say one of the first times you and I and our wives went out to dinner down in Tempe some little restaurant I still remember that. But I said so what's the next big thing and you're like well I think, I think a website and I thought and this was probably what '90 91 maybe I still remember looking at you just like what the hell is a website, you know? So I mean there's talks about technology in our lifetime, you're saying what's the future look like

I mean if that happened in that short period of time just think About so you know why I could recognize that so early, I mean we're all, we're all same species, same brain or you know um because when I grew up in Wichita, um at a very young age, um I knew what TV and radio and newspaper was one way. Because when a third of my friends' parents were small grains farmers and when you go spend the night with them as soon as the sun went down, the day's over there's no sunlight. So the old man would go in the barn and get on them ham radios and be talking back and forth, and then on the three-hour drive back from you know Fort Scott, you know rocking our ranch to Wichita, it was the CB radio and I loved interactive ham.

Radio CB radio, so a billboard and a newspaper didn't do anything, I want to talk, so the instant I saw my childhood memories were, I could talk to a dentist, yeah it was, it was, and and my everybody tried to stop me, everybody thought it was crazy, but um, you just you just know the social needs of a human, and I so desperately wanted to talk to another dentist, and now it's morphed into all these things, it'll be really exciting to see uh what new morphs around the corner, yeah that's what I'm saying, the future, yeah crazy stuff, so so uh if we're saying now that we're all three in agreement, it's probably a good idea to start as an associate you.

know work some of the bugs out of the system but then what do you do now you know like you're saying there are some guys they should just keep on doing that until they hang it up you know uh that's what percent is that 50 percent now that are just going to be an associate for life i i don't i don't know if we well first of all first of all let's not you know i um i think i've learned the most uh unintentionally i didn't know when i gave my first lecture in new york city in 1990 that you know now last week i was in israel i mean i have 50 countries so let me stop you on that one yeah i went to i think your second lecture did you go from new york to Detroit, on that it was one of the early ones, and there were five people in the room; I remember.

Yeah, you, me, my accountant, and two other guys. And about 20 minutes into the lecture, the other two guys left the room. Yeah, I thought you were complete lunatic. Yeah, I sat there through the whole thing and just loved every minute of it. I still remember that. Yeah, it was when you're when you're a 27-year-old kid lecturing to older humans; yeah, just naturally doesn't work. You know? A 60-year-old dentist isn't used to listening to it well at that point in my career. See, I had my own practice and I had to figure out like how do how do I make it better. Or how like that's what I want to speak to with guys today. I mean they have the same thing today; their resources are so much more.

You got all your dental town stuff and constantly we're like, well just go look on Dental Town, I mean you know, I mean so some terms of what you just said um, um you know, um. The herd acts as one; I've seen, I've been flying around for 30 years. So when politics is going to the left or the right, it's a herd thing um, when you know with their when the economy is expanding or contracting it's a I haven't really seen almost any isolated tribes that are working on an independent island from the rest of the the human so um, I would Say that um, some things that are really interesting is there; there's two million dentists right now treating almost you know 7.7 billion people, so let's just round that to eight billion.

So there's two million dentists treating eight billion people. And the first thing I noticed right out of the gate is in any country wherever there's no money, there's no men. So like in American education, this is all women. In dentistry, in all the poorest countries, we're all women. There's no money; men show up with a tie when they can make big bucks and they're either in government, military, or whatever. So the men are always in healthcare. Where they're making a lot of money, so as you've seen, uh, dental income peak in uh, you know, um at about $218,000. There's been drifting down about $3,800 a year just going down, down, down, and it's still really high, I mean it's still like $187 when the median household income they say the median household median income is uh $50,000 but median is average so if you want to get a good look at income inequality the the median is $51,000 but the the mean where half make more, half make less is only thirty one thousand

so do you know how many billionaires you have to be to drag 31,000 median to a $51,000 average and um so um um they still are making three Times the average household income, but so, but I do think if the trend continues of um personal dental income going down as it drifts lower and lower and lower, it will not attract men because I've only seen men attracted to money everywhere I've ever gone, they're in every profession that makes the most money and the profession that's the most violent, you know, uh, yeah, they're more attracted to military and money, so uh, so that's an interesting trend but um it'll be interesting uh so you, so you're, you're thinking right now in America which is only four and a half percent of the world's population, you're thinking that.

Half of the dentists coming out of school now will be employees their whole career. I'm throwing a guess out there, oh that's a guess, an educated guess after three decades. What did you... what are your thoughts? Yeah, I mean, I think that I think that's the financial barrier for us is a little bit too much of a hurdle, you know? From the people I've talked to at least in my age group, yeah, so the students are comfortable where they're at. You know, so the student loan and debt, they're looking at that debt number and they don't want to increase their debt on their balance sheet, yeah, by an office, yeah, essentially... as I ever talked. To them, kind of find their little niche and just write it out wherever and how, uh, satisfaction perception of the president minus what I expected.

Um, two years out of school are most what of that class of 120, you said 140, 140, how many of them you think, uh, yeah this is what I expected, I'm happy, I'm glad I did this and uh this is I'm satisfied, I think most people enjoy it. You know, it's kind of hard not to get a little bit jaded when you talk to the older dentists who now complain about the insurance reimbursements going down and down which I didn't know anything different, right, and they're like oh back in the day we used to, you know. they would just pay for all these crowns and we get all this money and stuff and now

it's everything's going down and dark clouds on the horizon and stuff so yeah then not knowing any different i'm kind of like well you know i'm doing okay and i'm pretty happy with what what's going on but you know we kind of i think i think that insurance war i see it heating up all over the place and it's not going to come down to you know there are checks and balances there's different stakeholders the patient sees dentistry different than the dentist the insurance companies they're only selling dental insurance to the insurance companies They're only selling dental insurance to private companies, um, because they're trying to attract and retain employees, yeah, so it's a dental benefit.

They're not dentists; it's just a matter of uh, how the uh lawyers see if they're playing fairly, you know, and uh, but uh, so that that's that's always been I mean when I got out of school the uh, um, but insurance has a whole nother podcast when you got out of school what was the percentage that started their own versus went to work for somebody else well, you know my gosh it seemed like it was going to be a lot of work for somebody else well, you know my gosh it seemed. like it was going to be a lot of work for somebody else like so many i just went and um started their own and what's funny 30 years later the the the 10 largest most successful practices i saw that they were all women dentists i mean there's like 10 women that walked out there and built million dollar practices just

smart decisions you know they'd leave kansas city and drive an hour out of town to some small town of five thousand get in some small old hundred year old building where all the employees want ten dollars an hour and just crushed it yeah that's still the case i think yeah i've seen so many of them and um but um like say I don't think the um I don't think the the human being is going to change, no, I don't think the girl or boy, any of that's going to change. I just think, um, the economics are going to, um, attract so you think DSO models will keep getting bigger and bigger well, so let's be very because I you know, let's be very specific whenever um I see and um I've witnessed so many of the first-level DSOs, let's just say um

group practice, one uh two to five locations, yeah, so you're in a town um and and these are usually towns of about um they're usually uh fifty thousand bigger, more likely than a hundred thousand, and every every town that's 250,000 someone. Realizes that, from The E-Myth, where um you know you're either working on your business or in your business. They get one layer of management and now um every office manager you'll ever meet if you stand behind her for one day, you'll realize she's not an office manager; she's answering the phone, checking in patients, seeing patients, doing financial arrangements. She just has this title I'm the office manager, and I'm like well I'm Batman, you know, and uh and um so um but they'll get an office manager, the only way you can have an office manager is when you get her out of a dental office into a headquarter building, so she's not.

checking in patients and then you can get a um one layer management then you need to know your number so you can get a number and um you know you get all the all the data then you have a marketing person who's only focused marketing like leave you to rick kirchner's headquarters for comfort dental it's not that big it's just you know it's just uh that building there's just like five or six guys there but they've been there forever and they're lawyers and they're marketing and they're cpas you know but they they they have the deal um that has always been massively efficient for the so they're in one one small town of a hundred Thousand and they decide to go to an East-West with a downtown headquarter one-layer management, okay all those offices where say the average office is doing uh say you know uh you know your standard mass 750 taking home a buck 75,

these offices all go they all pass the million to the million four, they just run better because the dentists are doing the dentistry right and they're doing one-layer management where I don't understand, well I actually understand and and Wall Street won't take any of them public is the second layer of management which you know a headquarters so you have this um like Arizona and a DSO might have. 30 locations in arizona and a management team out here in arizona but they got a headquarter team back say in you know effingham illinois for heartland or new york or bob fontana or whatever and those guys um and a lot of them those guys want need another 14 to 17 percent off the top well what what can they do

to justify i mean how might my lab and supplies is that much money can they do something so efficient where now they get rid of my lab bill and supply bill so you see that all through economic history where an industry starts adding so many layers of management the government's the best at it because a government is um you Know it's a corporation of people, and each individual doesn't want to die, so the the bureaucracy doesn't want to die, so you start any agency, it never wants to die, it always wants a die to grow, expand, keep reinventing itself, and then you show up later and you're like, 'What the hell is going on in this agency?' So all through history, you have that cycle where they start adding layers, layers, layers, layers, and then they deconsolidate, layer them, spin off the companies, sell all the parts and pieces.

So I think dentistry is well served with a one-layer management running five locations in a town. Down to the individual level, it's a scale different success when it's the man and wife, and I saw this in small grain farmers with them when the old man was sitting on the John Deere, and the wife was at the kitchen table on a calculator with her notebooks doing all the buying and selling and running the business, you know. When you had those two partners, it was very, very good. But for an individual, you know I have a partner, I mean, you know I have my back. That man Lori, he's been with me 20 years, and I got a I got a bunch of people who've been with me several decades that they run the whole show.

But so, but the second layer DSO, I don't see them going public. I mean when Snapchat can go public and you know what that technology was designed for, you know, to send someone a nudie picture and then they look at it and it goes away and that can go public but dentistry can't. Well, there's only one has only one has gone public, right? Burner perfect teeth or what. Yeah, but there is a public. But that's a long time ago and it's a penny stock and it's not on NASDAQ or NYSE. Now there's two in Australia and one in Singapore and they all three have the same model. No hygienist seven days, seven to seven, seven days a week. They get the young kids out of school; they provide a job.

The average kid stays five years, they lose 20 doctors a year. Aspen, now you're a little more in touch than I am, I guess. You do this all the time, but aren't they offering some equity positions. Well, Aspen is Bob Fontana and Pacific Dental is Steve Thorne, and I think I think everybody's aware that the final business model hasn't evolved yet. So they're all trying and innovating and you have to fail forward. I mean, the Japanese said, 'You know, successful man fall down seven times, get up eight.' So they're all innovating different things about the equity. Yeah. And you know if you put money into something, you got to get it out. That's why the stock market is so amazing because you can; it's liquid, you can convert your stock back to cash instantly.

But when you own land, that can be a long time; when you own a dental office. Rick Workman told me the other day, a couple days for Christmas, that he's got dental offices in small rural areas that he couldn't give away. They're just there's just no liquidity and that's why he's moving to the big city even though there's more demand in the rural is because there's no liquidity of your investment in the rural. But if a single person like you, like my son, my oldest son, lives in Beeville, and they love that that lifestyle out there in the country. And I mean it was just crazy, different week there than living in Phoenix. I mean, it's just where is that going to go though? I mean, eventually, you can't have everybody, you know, everybody in the city.

You've got to be somebody taking care of the rural areas, and and I see the same thing works. You're talking about those like the thumbs up areas, they're in the middle of nowhere. They have the big volume. But then it's hard to get a baby boomer to go. So if I find a kid like you, married with a child, and congratulations on that baby, and you qualify, you can do that rural thing. But if you're a bachelor, I mean they're on dental 10 all the time like oh I'm in a small town, I'm working associates. It's only five thousand people in town. I'm crushing it. I'm learning how to place implants. I'm making money hand over fist. And then I can't afford to come home and I'm all lonely and there's no one to date or find in my little rural area.

So, what your girl was doing you had to live live where you want to live but you know drive you can drive an hour away and be in a total different demographic right. Well, the thing that the dentist never wants to hear, you know they're in a very non-competitive industry. So, if you think dentistry is competitive, yeah, it's more competitive now than it was 30 years ago. But look at restaurants 20 to 40 percent of them go bankrupt the first year and dentistry when you buy a dental office. Only point four percent go bankrupt. You have a point four percent chance, and usually that's because you know you're drinking whiskey or swallowing opium or you know you got arrested so something really went wrong. So dentistry is not competitive.

So at the end of the day, you see all these trends and norms in the way they know have to do anything they are they're a doctor of dental surgery and the richest superpower on earth. I mean isn't it funny with that stat point. So, yeah, I didn't know you're going to place in. Yeah, but you never really did jokes like 4% all dentists wouldn't you know to me it doesn't I guess I guess as a business guy I mean why wouldn't you I mean you don't you don't get that ratio or anywhere on anything else you only have a point I would think 99% of the dentists would go out and try to. Well, it comes down to why, how many hours have you spent playing guitar in your life?

Oh gosh. And I've spent none, it's just your preference; I mean you like music, and they don't like management, and it's; I see more and more the trend is they weren't initially attracted to playing the guitar or management but after working at a different associate job every year for five years they finally get so miserable that they only do it because they're just miserable and those were the best employees I've ever hired in my life. Oh, guys, it is. The best employees I ever hired in my life was um I love what I do and I'm so sick of doing it over here and then internally here promotions um in my 30 years the persons that turned down the promotion says hell no I don't want to manage the other these or whatever whatever and then they have a new manager and then that doesn't work out in a new manager and finally they're just like oh my god I'm gonna I'm gonna have to do this myself and then they're perfect.

Okay so that's that. So they've got to have preference. What makes the you said the student out of school a year or two or three years they're just miserable why are they so miserable? Well you know um um if you were born I have noticed if you were born in free enterprise you know your dad owned the wheat farm or the restaurant or a business um those are the ones that grew a love for just because they that's all they knew you know they their dad and mom were calling the shots and that's they knew. The the the child whose mom and dad were an employee, they're unfamiliar with wearing all these business hats so they feel more comfortable getting a job.

But then you know they're a dentist and they go work somewhere and um, you know the um the older dentist is cementing crowns with open margins but then on new patients anything half that open margin he's telling him to redo the crown but he's not doing his and he's got hygienists telling you know office stuff he's doing too many fillings and not enough crowns or he needs to use the CAD CAM and not the lab, he's not enough control. I don't want to be a lab man, I okay that's what makes him miserable or yeah or or the direction the office is going like um, I Would never want to be a cosmetic dentist, I mean I don't even, I don't even understand it, especially on the molars.

I mean, I'm a dentist for 32 years; I almost never see someone's molar, you know. It's always these front 10 teeth and then you're doing some Empress glass second molar. Bonding, you know, um, and then you got people that you know, um, why, um, do they want to look more pretty, you know? There's there's a lot of people that oh, you know, it'd be kind of fun to look better, yeah. But a lot of those cosmetic cases, that's not that's good advice I think that's good advice on this trend that we're taking here because don't do that, don't become a cosmetic be a general dentist that does extractions and ortho and you know, and there's research on that cosmetics, I mean, do you know by the time you've had your fifth cosmetic procedure done.

you're at the funny farm you're seeing a shrink you're on medication I mean you know it's always um you're fixing up your kid because you want him to get married because you really only want a grandkid I mean the only reason you had your kid was for a grandkid you know that's that's uh that's the only reason you never killed your kid is to get a grandkid so you're fixing them up because you want them to attract a mate and make you a grandkid but the other group is I just got divorced I'm back on the market. Why'd you get divorced because I was batshit crazy okay so what do you want to do now uh you make me look like I'm 18 again and so but the bottom line is forget all that it's it's um when you do things you don't like to do for money it never ends well um just uh just uh learn learn to like it.

If you're a dentist and you say I'd rather be beaten with a stick than do a molar endo well you can't afford to do a molar endo because that molar endo will take the smile off your face. Yep. I think the worst thing they do is, they give employees they don't like money to stay with them and little kids in the sandbox. I just saw it this weekend, I mean you know, you meet another friend, he's got grandkids, but the grandkids, they just don't click; they go to run two different ways, and then you tell your grandkid, um, maybe you should go, you know, ask him if he wants to ride the guy car, and he just said, 'I don't like him,' and then he just runs off, just real honest.

But now, you I mean, I've been in so many dental offices where uh, the dentist says, 'Look, I don't care; you're so annoying.' Let's step outside because I'm afraid the hygienist might come back here. Like, you're hiding from your hygienist? You're hiding from your hygienist. Don't do that. You know so so once you get it to where you're all playing in the bathtub with the same toys in the sandbox uh you know just get rid of toxic people in your personal life, your marriage, your business just um and dental town there's so many threads on um what to do with this employee and the opening deal it's like what is she up to? To do to get fired? Does she have to run over you with a car?

I mean, in paragraph two, what are we talking about? You know, there's 8 billion people on there. Then that one ain't working for you. Okay. So trying to stay focused on these recommendations, though, you know, we're, we're in agreement, the associate thing that we're talking about buying and Kushner has an unlimited number of, and not unlimited, but a ton of associates, right? I mean, he does; I don't know if he does; he does partnership. He didn’t have any associates. They’re all partners. He has 300 locations. So he’s the all partner. That's right. Yeah. He's got 300 locations. But Workman would be all associate. Yeah. Okay. So you got two, one's all partner, one's all associate. Which of these recommendations are we making for, you know, the homie, the new group, the new, the new graduates, Dan’s age?

Well, I mean, I think everything we said, I think, you know, I think the most important thing to do when you go to school is find a mentor. You've got to remember that dentistry for the first century, from Pierre Fauchard on was an apprenticeship. They didn't have all these dental schools. That's fantastic advice right there, by the way. Yeah. They, dentistry. Find somebody. I had a mentor, like when I was in college, it was an orthodontist. I go to his office. That's why I wanted to get into ortho. Because I just go, I love going to his office and putting bands on; but you're right. That's a great recommendation. Yeah. And my mentor is my next-door neighbor, Kenny Anderson, who's still practicing 50 years later, just a solid mentor.

So the first century, it's all apprenticeship. It's all apprentice. And then when they get out, it all comes down to what percent am I going to make? And that's wrong. If you're if you're if you're naturally attracted to implants, go find an implant surgeon mentor. If you want to do Invisalign, go find an Invisalign guy. Find out what you like, more importantly, find out what you don't like, go find a mentor. And you, and I have mentors in every category, you know, I had them for a different one for implants than endo or business versus marketing. So that's what I liked about Dentaltown is you, you know, I have like 20 different mentors that I follow every word they say, because they just, they're out further in that one little area than anyone else.

And then and then the finance is easy. Just learn to make more than you spend. And everybody wants to go become a dentist and build their business and be a millionaire, but they never ever put the foot on the brake of any spending. And a lot of them think they do all the time. And, and you just sit down with them. That's why I love math because there's no woulda shoulda coulda. It's like, okay, the average person spends this on a car. Look what you spend. The average person goes on vacation, camping at the lake. You went on an airplane, on a cruise, on a jet to an, you know, it's just the average person eats out 19 times a week, but it's at a fast food restaurant.

You go to wine and dine. I mean, it's just like every freaking category they're off the charts spend. So, so now it's the cat chasing its tail and you can never have that free cash flow to pay down debt, to invest. I mean, back in the day, if you put $1 in the bank, it would pay you a nickel a year, the rest of your life. That's why the Rockefeller foundation is still going. Because he put that money in a foundation and it's still spinning off a nickel each year for every dollar. And most dentists that I know, even as 65, they spent their whole life paying a nickel to that other person's dollar. So their whole life, everything cost, 5% more. I mean, I know a dentist.

Um, I know a dentist just recently as old as me just bought a new home. That's bigger on a 30-year mortgage. Dude, you're already dead. And so, so, so, so making the transition, so you don't like the student loan debt, you say, yeah, but you, but it was, but it was a great business move because leverage, because if you would have worked at McDonald's for $15 an hour and saved up until you could go to dental school and cash. Yep. You wouldn't be a dentist. So you're 40 or 50. So you knew the leverage of borrowing other people's money. When I'm making $15 an hour, go get a dental degree and pay it back when I make $100 an hour. That's leverage of other people's money to leverage up yourself.

But from that day forward, um, the next big leverage would be to own your own office. Um, this, the math is clear. If you're an average dentist employee, you're making under $200,000, you make a hundred thousand dollars a year more as a general dentist. Who owns their own business than the average median dentist who is an employee, um, specialty. Um, you know, in 1900, we had no specialties by 2000. The physicians had 58, we had nine. It's all specializing. The average specialist makes a hundred thousand more than a general dentist. And a lot of dentists say they, they, um, they give up too easy. They'll say, 'Well, I wanted to be an orthodontist and I didn't get accepted. So now I'm an ASPEN and I cry routinely.' Well, how could I be an orthodontist?

Well, how could I be an orthodontist? Well, how could I be an orthodontist? Well, how come whenever I go to these, uh, the Caribbean, I meet Americans who didn't get accepted into dental school or grad school. They go down there, they get their license for half the price in the Caribbean where you can go see fish and daily. And then they come back and they're an orthodontist and no one cares that they were a dentist from Detroit, Michigan, and an orthodontist from the Bahamas. And, uh, and I, and some of the greatest dentists I know in California, I went to dental school in Mexico and it wasn't even because they couldn't get in the United States school. They couldn't get in the United States school. They couldn't get into the United States school.

They couldn't get into the United States school. They just wanted to go to Mexico. That's where they're from. And, um, so, um, so, so if you, if you, uh, work for yourself, you make a hundred more than, and you're a specialist, you'll make another hundred more. And, um, and that is where the root of the partnership problems go down the drain and the marriage problems go down and drain is, um, the use of cashflow. So we made a dollar profit and you want to go buy a new one app laser for a hundred thousand. And the other partner is saying, well, let's pay down that dollar debt, or let's put a dollar in the bank. That'll pay me a nickel a month until, you know, the earth is engulfed by the sun.

Point well made some very good points in there, Howard. So you're the man and teaching, uh, stuff. So do you have, do you have any questions? I, I, what I, what I love about you is, um, here's two old farts and we know our audience, a quarter of them are still in dental school and, uh, the rest are all under 30. Send me an email, howard at dentaltown.com. Um, so I know what, where, where you are, how old you are, what country you are. And it's so exciting. Um, again, the herd is so homogenous. The emails are equal from all around. I mean, they come in from routinely from, uh, every country I've lectured at in the last 30 years. And it's so fun to be able to talk to them without flying 15 hours to their country.

But we're, um, let's know two old guys talking. What, what are your thoughts are? Well, you know, it's just trying to figure it out. Like we kind of covered earlier. We got minimal experience in dental school, I thought at least, but, you know, just trying to get the clinical skills going and figure out how to make my mistakes and learn from them and what I gotta go from my associateship to take it to the next step, you know? And is there any area of the, um, dentistry that you're more, um, enamored with? I've always been really liking, uh, endodontics. Nice. You know, I'm a little bit scared of them. It could be a little tricky. And some people tell me that's just, there's this kind of like magic, you know, no one really knows what works and what doesn't.

He just, that's right. I got to, um, I got to show you a chart. Um, uh, we had the, um, founder and, uh, Heartland dental on, but we've also had his, um, Pat Bauer, who's been his office, uh, president and CEO. But I think it's, uh, I've heard this from so many DSOs. Look, look how brutal they are on, um, on endo. So when they, when the, when, when I talk to anybody who has 30 to a hundred or more locations in Heartland has a thousand, um, they, um, they said all their profitable, um, locations are bread and butter dentistry or oral surgery, endo fillings, cleaning exam. And, um, they, um, uh, what was, um, if they, I thought I had another data chart, but when they buy, um, um, they have a 64% overhead plus the dentist hygiene, 8% assistant, 6% business admin, 6% total staff salary, 20% lab five supplies for dentists paid 25% of collection.

Um, um, but if they pick a location, where is that a note I had? Um, if they pick a location and, um, um, and it's not doing well. Seven roots. Okay. Here it is. Um, bread and butter successful offices are getting patients out of pain and a new practice must do seven root canals a month or they know from a historical three decades that it'll, it'll never be profitable. So if you're not so right out of the gate, um, like, like Starbucks is really neat. Like, you know, they'll, um, you know, like in agriculture or they'll, they'll plant three trees here because one of them might die and then they selectively prune them back. Starbucks. And I love Howard Schultz because he would open up a gazillion, like, like other people wouldn't know which corner in Manhattan to put the Starbucks on Schultz to put them on both.

And they both worked and whichever one didn't work was when he, he would prune back. And these guys, they open up new offices. And if they're not getting, if they're not doing seven root canals a month, they immediately, um, go to the greater fool theory, which is try to sell someone else. That's what you do when you, when you look at these absurd stock levels, no matter, I mean, Warren Buffett sitting on 130 billion in cash, he sees nothing. You could buy at those prices. But no matter what stock you own, there's somebody who will buy it from you. So they immediately start trying to sell, um, those offices to a greater fool and going somewhere else. So, um, so I think, um, it's amazing. So my advice would just be, uh, be happy.

You're only going to live once. So don't do it with toxic people and don't do procedures you hate for money. Um, and, um, and, um, and, um, time you have a thought on how to grow your business, have two thoughts on how to cut your own personal overhead. And it's funny how the most vocal dentist I know on Dentaltown and social media, talking about how you know the government should cut all these entitlements and spending or whatever. And I'm just sitting there saying, 'Look at your spouse; you can't even get Muffy you can't get Muffy to shave one dollar.' But oh, but oh but the the president should easily be able to do it for 325 million people. And your wife destroys ten thousand dollars a month since I've met her just every month they destroy ten thousand dollars of capital.

It's it's just amazing. And women dentists know this; so are they gonna marry a man who destroys ten thousand a month in capital and they're a female dentist? No, they marry a man with a job. Yeah, so women dentists can have shorter careers, be happy, stay home, have kids, do all these things because. Their partner creates capital instead of destroys capital, so what’s the difference? You know I’m 25. I married the female dentist in my class who makes ten thousand dollars a month. So at the end of the 65 that’s five million versus the other one that destroys capital, negative five million, that's a ten million dollar difference. And if you can just get them to go into your house, and they also don’t realize the cycle of them credit card debt, to take a fancy vacation at Christmas to Maui and all that all these thousands of dollars is what’s gonna be causing them the stress and strain, so then they’ll go back to their old friend.

To Maui again and they just and and simplicity is elegant and just lower your standard of living while you expand your creation of capital, it's just it's so easy. So on that note are you gonna start playing? So, so you brought your guitar, I did! I didn't know if you're gonna... well, you're the only person who's ever brought a guitar. Well that's what I thought it's New Year's Eve and that's unique and then I was hoping I was the only one to ever bring a guitar but I wasn't sure well you are and and you have more musical roots you got it's up before you start your story you went to high school with Madonna I did who's the greatest female rock and roll musician of all time maybe she was one of our cheerleaders so yeah I knew Madonna I don't know her now of course if all the people listening to this podcast maybe she's.

Well Madonna's got a dentist so her dentist might hear this now but I think I've heard you mention her a couple times in 30 years and I thought what was the most interesting thing you first said I was pinning yeah what was she like you said man she took all the advanced classes she's a calculus bio and you said her one time you said she's in high school you told her you're gonna be a dentist Madonna you've got the same calculus physics chemistry. You could be a dentist, and she told you know I'm going to go to New York and be a rock star, and you just thought what the hell, wow, what she wants, yeah. And she came from a big Catholic family, and yeah, you're right in Michigan, right?

And my God, well, slightly a little more recently though we had this weird thing happen with one of our neighborhood people, is Kid Rock, and he was filming a commercial and drove by our house and we have a real nice backyard with a lake and everything, and said. You know, can you know I pay you guys to film my commercial in your backyard, and you know that was just a blast wasn't it? We had three days of him and his crew over there filming a commercial. And, oh, I think of Detroit is Kiss the most favorite Carl Misch course I did is seven; three-day weekend thing and Kiss was playing one night, and the whole class went over to watch Kiss, and oh my God, that those songs!

That was Detroit, yeah, Detroit Rock City, yeah, Dr. Love, yeah, that's my God! What a Motown. So, Kid Rock is, you know, in our house, and and I said to him, I'm like, 'You know, would you... I'm a dentist, I said, but you know, I'm kind of a musician on the side too, you know, and he says, 'Yeah, said, would you do it, you know? Just we'll do a song together, sure, what do you want to do?' So I said, so I did, I said, just follow me, you know. A lot and he's a musician, so he knew exactly what to say. And I'd say. 'All her teeth are brown.' He'd say, 'Her teeth are brown, and her gums are gray. Her gums are gray.' Yeah, so he was cool about it, I mean, you know.

He just like, 'Who is this guy, you know?' But we did that song, we, we, you know, kind of bonded on that, and it was a lot of fun, but yeah, back in nineteen... this was, this was what eighty-eight I think, I produced this CD, Dental Doc, in the 60's. Now, is it on YouTube right now? Dental Doc and I've asked you that before. We know I need somebody; can we, can we put this CD at the end of the podcast, whatever you want to do with it? Oh, it's so cool because I've been listening to these forever they're songs about dentistry! They're all that's all they are, a whole bunch and we all, we all work in a small mouth.

So it's, you know, I took all these parodies for your audience, you know, and if they're all young, a lot of them are going to think that's an old song. You know, but they're all old songs for us. But there are; I'm amazed at how these kids all know the old music that's true. I mean, would you say you knew all most of them? Yeah, maybe you know like a seven-year-old kid at Walgreens over Christmas had a Rolling Stones shirt on. I said, 'Kid, you know who that on your shirt?' He goes, 'Rolling Stones.' I said, 'You know any of their songs,' and he rattled off like, 'Oh, we have to start me up' album, 'Sweet' and 'Tattoo You.' I couldn't believe he said that.

Yeah, no, I love all the you know; we're from that gym so I don't know, yeah, that's great if you want to do something with that, you want me to play anything? We got to play one song live, okay, we'll put all these on the end of it. I'll just do 'I've Always'... I like I have a harmonica because it can make my... when I don't have a band or something, it's kind of my like Neil Young and yeah, Neil was where you know; I do have a Neil Young but I can't. You're welcome, yeah. Let me do a John Mellencamp. I work in a small mouth, I drill in the same small mouth, and I can numb up a small mouth, yeah, yeah. But I can barely see, and all my patients have small mouths; they're friends, yeah, same small mouths. I wish they had big mouths. Except for when

That is awesome. That is awesome. Something to end our year on. End our decade. The end of the decade. Man, thanks so much on your vacation. Oh, we love coming out here. We're so geeked. Who works at Dental Podcast in the middle of their Christmas, New Year's vacation? And thanks for coming down here and to help transfer knowledge from the old generation to the next generation, so they can have a better 2020 vision of where they're going. Right. It was an honor to have you guys today. Well, thank you so much. Happy New Year. Thanks, Howard. Happy New Year.

Oh, teeth are brown. Her teeth are brown. And her gums are gray. And her gums are gray. She ain't brushed her teeth. She ain't brushed her teeth. For many a day. For many a day. How am I to tell her? How am I to tell her? They're not gonna stay. Not gonna stay. Peridonal disease, peridonal disease, peridonal disease, peridonal disease. We'll take a ticket today. She stepped up to the front, up to the front, after I had my stay, I had my stay, and the secretary asked her, secretary asked her, are you gonna pay, are you gonna pay, and she broke apart, she broke apart, her teeth began to sway, began to sway. Ooh, periodontal disease, periodontal disease, will take your teeth away, take your teeth away. All her teeth were gone. All her teeth were gone. And her gums are gray. Oh, she ain't brushed her teeth. For many a day. How am I to tell her? How am I to tell her? They're not gonna stay. Not gonna stay. Oh, periodontal disease, periodontal disease, will take your teeth away. And her gums are gray, oh, periodontal disease, periodontal disease, will take your teeth away,

Damn, I said to her You know the rubber one Damn, she said to me Could you just put the clamp Where I can see And put that thing around his chin Oh, no, no, no The latex is much too thin Damn, damn that rubber dam It makes me feel less than I am Damn, damn that rubber dam Who's gonna hold The acu-cam? Well, I think we got it set. Oh, no, no, the field is. It's getting wet. Now the clamp is coming off. And oh, no, the patient Has to cough. Oh, damn that rubber dam! It makes me feel less than I am. Damn, damn that rubber dam! Don't think you can hold The acucam. So now you think you're claustrophobic. Well, I believe that way you ripped it off. And now you think you're claustrophobic. Well, I think you're claustrophobic. And now I haven't started yet. Oh, what do you mean you don't care If the whole thing's getting wet? Oh, oh damn, damn that rubber dam! It makes me feel less than I am. Oh, damn that rubber dam. Don't think that we can use the acu-cam! Damn, damn that rubber dam, damn, damn that rubber dam.

Why don't you open up just a little bit wider? Please, please say you will. Cause my assistant won't mind and my neck will think it's fine if you let the light shine. Get done on time. So one more time. So won't you please open up a bit wider? Please say you will, say you will. So won't you please open up a bit wider? Just a little bit wider, please. Say you'll... You gotta twist it up, baby! Twist it up, baby! Get it out, get it out, get it out! Move it out, baby, move it out, baby! You gotta yank it out, yank it out! Twist it left, then pull it all right, pull it out right! You gotta get it out, baby! Get it out, baby! Or I'll be up all night. Or I'll be up all night...

Ow. Did that work?

I work in a small mouth And I drill in the same small mouth I can numb up a small mouth But I can barely see All my patients have small mouths And their friends have the same small mouth I wish they had big mouths Except for when they talk to me It's hard to work in a small mouth It's hard to see what I want to see If my patients all had big mouths It'd really help my dentistry

They got the dental office blues, babe They're gonna drool all over you Oh, that's nasty stuff They got the dental office blues, babe Got rubber bass on their new suit It won't come off You thought that they were numb Till you put that thing into their gum Now you're trying to peel them off the roof They got the dental office blues, babe You know that they don't like you They got the dental office blues, Babe, you know that they don't like you. And when that four-year-old bites you on the hand. You knock over your new dental cam. You bust a thing. You break it right into two. You got the dental office blues, babe. You just broke a Roo-Tip off number one, oh no, they got the dental office blues. babe baby and the patient's a lawyer and so's his son oh it's a crying time baby but well don't despair it'll get better in there and you won't have the dental office blues no more

Lord have mercy

He closed his eyes Only for a moment But the crown was gone Down it went Somehow it got lodged In his esophagus Ooh Crown going down It got stuck halfway But finally made it down Ooh Crown going down Just wait a couple days Then bring it back around

It's the same old song This time it was in the mouth And suddenly gone Down it went We just told him in the morning Bring it back again Ooh, crown going down Wait a couple days Bring it back around Ooh, crown going down It's just another game Of lost and found

You ready?

If I had a dental mallet, Oh, I'd hammer that crown on. I'd hammer that fridge off. Oh, I wouldn't need the gas. I’d hammer in implants. I’d hammer off on lays. I’d talk about love Between my front desk and back crew. Oh, one big happy clan!

If I had a dental laser, Oh, I’d use it in the morning. I'd use it as a pointer. Oh, and I’d have a great ass. I'd spend a big fortune. I'd build a big office. But I’d still talk about love Between my front desk and back crew. Oh, one big happy clan!

So I got my dental mallet, Oh! I'm hammering that crown on. I hammer those bridges off. I never use a gas, I hammer on all the lace. I hammer in the implants. I still talk about love Between my front desk and the back crew. There was one big happy clan;

a root tip has broken on a third molar, and I can see it on the X-ray, and it's a big section, so I should retrieve it, and the oral surgeon is gone for the day, so bring out the east, west, and my barn Parker, go find some sutures and the stale gauze, and get me a handpiece. Is this to stay vital? Tell our next patients we won't be long; at least we hope not. Bring the light closer; must be there somewhere, but it's just not moving. Oh, it looks quite long. A prayer to the tooth gods; I'll refer the next one, thank God in heaven, it's coming out.



Well, how many times must I tell you? You gotta brush and floss every day. And how many times have I seen you, my friend, In my office in the past decade? Ooh, and how many people get grossed out each time you open your dirty mouth up? Ooh, your front teeth, my friend, that is blowin' in the wind! Your front teeth are blowin' in the wind. How many years will your gums Hold on to me? Hold on to those danglin' Brown pearly whites Ooh, and how many times in the drugstore did you miss the Crest to get the lights? Not talkin' about bulbs here. Your front teeth, my friend! That is danglin' in the wind. Your front teeth are blowin' in the wind. Oh, good!

Everybody now, here we go. Your front teeth, my friend! That is flopping in the wind. Your front teeth are dangling in the wind. Now I want everybody, everybody with teeth and without. Front teeth, my friend! That is hanging in the wind. They're just there. Front teeth are flopping and your front teeth are just dangling Your front teeth are just blowing in the wind.

When I find myself on that last molar trying to do an MOD open just a little wider, please. When I get miss, I'm a gagger trying to put her lunch on me. Hold back the salami, please! And let me see, let me see, let me see, let me see. I wish I had my fiber optic clean. When the four-year-old screams so loud, my ears ring to infinity. When the four-year-old screams so loud, Mom says, 'Take it out.' The kid's a brat, not going home with me. Let me see, let me see, let me see, let me see. I'm sure glad I didn't get my pedo degree. Let me see, let me see, let me see! Let me see, let me see, let me see! It's times like this I wish I chose podiatry.

You can come in now, Mrs. Gaggard. La, la, la! What I was saying is that this is a song that's the dad's a dentist and he's working on his teenage daughter. And it goes like this: one, two, three, four.

Oh, nitrous is the place to be, I want my serenity. Turn the level up nice and high. You better give me that stuff; you don't want me to cry. Now listen, I'm the dad. Just numb is where you should be. That mess makes it hard to see. And that nitrous makes you want to hurl. So let's get started, you silly little girl. Open wide. I'm tired. We're almost there. I don't care. You are my child. Goodbye to my smile. Goodbye to my smile. Nitrous, turn it up. Oh, I'm tired. Almost there. I don't care. You are my child. Goodbye to my smile. Nitrous, turn it up.



Sit right back and you'll hear a tale. A tale of a pissed off staff. Started over something small. A bad front desk. Schedule started getting full. Staff was getting tense. Then the call from Mrs. Jones. Put them over the fence. It put them over the fence. She said her tooth had fallen off. And had to be re-glued. Was the third emergency of the day. She must be out by two. Had to leave by two. The front desk surely wrote her in at 145 between a four-year-old screaming kid and an endo on tooth five. An endo on tooth five. Endo on tooth five. Soon the day was running late. We knew we were behind. With rooms to clean. And sterilize. People to check out. Hygiene checks. All the mess. Staff without.

A smile. Oh, right now, right about then she walked on in. Sat behind the wall. No one saw her there. Tensions in the air. And then another call. Soon the time was way past two. Mrs. Jones became a rate. Words were harsh before she left. She said she couldn't wait. She said she couldn't wait. The staff all knew the doc was mad. Mrs. Jones had left today. She'd surely tell her twelve best friends. We were an awful place. We were an awful place. The most. We're an awful place. The front desk said. It was the fault of the people in the back. Words were said. Names were called. It was a terrible verbal attack. A terrible verbal attack. Soon I knew they would explode. And I'd get in it my ear! If the front desk man, hygienist, and assistants were on fire, the doctor has more heartburn. Staff without a smile. Staff without a smile. Yeah!

Well, this story is purely fictional. Because with our great staffs, I know it wouldn't happen to you. I just wrote it for laughs. I wrote it just for laughs.

Write them out!

People are what we all treat. Their teeth are what's inside. You can make a four-year-old laugh. You can make a grown man cry. Well, don't you know it's in your hands? It's up to you and I. Come on, people now, let's smile on your mother. To look a whole lot better. Take what's best for one another right now.

Teeth will come and teeth will go. Exims we all have passed. When it's all said and done. We hope our work will last. Cause in the end time we'll tell What we've done was good. Come on, people now, let's smile on your brother. To look a whole lot better. Do what's best for one another right now. Come on, people now, let's smile on your brother. To look a whole lot better. Do what's best for one another right now.

I heard you knocking at my office door. Wanted to leave, Not one patient more, but this had happened many times before. There was a person who was in some pain. They probably needed to have something drained; I guess I couldn't let them walk away. I've seen the needle and the damage done. We try to lend a hand to everyone. Cause when their needs are met, our jobs are done.

You can stop now.