Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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1509 Dr. Suzanne Ebert of ADA Practice Transitions on Finding the Right Match in a New Practice : Dentistry Uncensored with Howard Farran

1509 Dr. Suzanne Ebert of ADA Practice Transitions on Finding the Right Match in a New Practice : Dentistry Uncensored with Howard Farran

11/27/2020 4:00:00 AM   |   Comments: 0   |   Views: 286
Dr. Suzanne Ebert graduated from University Of Louisville College Of Dentistry in 1998. After completing a residency, she started a solo private practice and enjoyed being a private practitioner for 11 years. Upon the sale of her practice, she elected to continue her career by providing dental care to indigent populations as the Dental Director at a local Federally Qualified Health Center. As Adjunct Faculty for the University of Florida, she had the privilege of working directly with senior dental students as they rotated through the clinics. Dr. Ebert is unwavering in her desire to protect private practice dentistry. She is a vocal advocate of having a strong association to lead the dental profession through the issues facing it today.

VIDEO - DUwHF #1509 - Suzanne Ebert

AUDIO - DUwHF #1509 - Suzanne Ebert

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Please excuse any typos as this was digitally transcribed.

It is just a huge honor today to be podcast interviewing Dr Suzanne Marie Ebert DDS who graduated from the university of Louisville college of dentistry following a one-year gpr she entered private practice as an associate in st Augustine Florida she started her solo private practice in Ponte Veda beach Florida where she treated friends and family for 11 years upon the sell of her practice she elected to continue to continue her care providing dental care to indigent populations by becoming the dental director at a locally federally qualified health center under her tenure the clinics expanded ran efficiently and profitably while addressing real needs in the community including elder care special needs care and er diversion dr Ebert also became heavily involved in Florida dental association leadership where my classmate Cesar Sabotas just became the president-elect go Caesar rising through the chairs of her local component and ultimately into the position of trustee for the Florida dental association as adjunct faculty for the university of Florida she had the privilege of working directly with senior dental students as they rotated through her clinics dr Ebert considers herself a clinical dentist first and is unwavering in her desire to protect private practice dentistry she is a vocal advocate of having a strong association to lead the dental profession through the issues facing it today dr Ebert is currently the vice president of dental practice and relationship management for the ada business innovation groups um so she did her gpr university of Florida her DMD at university of Louisville did i say Louisville right Louisville you have to put a bunch of marbles in your mouth first Howard oh my gosh you won't believe this if i tell you i mean this you can't make this stuff up so my dad i learned everything from my dad we had five sonic drive-ins in Wichita but he wanted to go global so he went north put one Abilene Kansas car Nebraska went south down to Childress Texas and for east it was it was Louisville so i was always the summer between every high school year i was always on the opening crew of a new restaurant so i spent a summer in Louisville and that was so damn cool uh my gosh the only bad thing i did there was um when we first pulled in we saw our first tobacco field so i wanted to jump out and pull a couple to take back home you know to save them as souvenirs and uh evidently you can't you can do that in Iowa corn farms but uh you you can't pull a tobacco plant out of the ground and i learned that at about 14 years old that got shot but um my gosh i wonder if you uh to start this out if you could just go back in time to when you graduated from Louisville um what the hell are they supposed to do they graduated in the middle of a pandemic now the the class of 2020 i i I’m doing this podcast i don't really care about a bunch of 58 year old fat bald dentists who have six grandchildren and debt-free and money i I’m worried about these kids coming out of school with four hundred thousand dollars in student loans um the um you're in this um um doing a lot of in the practice transitions let me tell you how bad that is dental town always had um we've always had free classified ads and we've always had about a thousand dentists selling their practice listed and about 5 000 jobs now it's 2 000 dentists saying I’m done I’m out of here and only 1 000 jobs so these kids are coming out of school the only people hiring are dsos which is why I’ve been trying to podcast all the dsos here in Arizona i had so many young kids saying well who owns mp2 you know i do that guy so i you know i did dr v um my gosh um what what advice would you give them well what you're talking about is one of the main reasons i got into this role at ada practice transitions i worked with senior dental students for six and a half years they rotated in two week rotations through my clinic and when they would come into the clinic i would always ask so what are you going to do next year and the ones that weren't going into a residency and weren't going into a family practice that they already had established they had no idea what to do so the common response was i have absolutely no options I’m just going to go work in a dso and i said well you actually do have some options let's go over those options and i think what resonated the most with me was towards the end of that six and a half years i noticed that i kept hearing the same thing over again i know I’m gonna hate my first year in practice and i said you're graduating with 400 000 in student debt and you're telling me that it's okay for you to hate your first year in practice that doesn't make any sense to me so let's go over what your your options really are you do have some private practice options you just need to go looking for them you have to have a place where you can land that's going to help you develop the skill set that you want to develop so find a place that shares the way you want to practice find a dentist that you really respect you respect what they're doing both clinically you respect the way they treat their staff you respect the way they interact with their community if you can find that how great would it be to go in and be an associate within that practice and potentially take it over someday I’m hoping that some of them took my advice i actually know a couple that did and they were very successful at it and when i heard about ada practice transitions i thought this is an opportunity for me to make a difference in many young dentist lives and help them to find a place where they can be personally and financially successful this group that you're talking about right now that's graduating Howard i can't even imagine how they are feeling as they're entering this either last year of dental school or they graduated in 2020. we all know that their clinical time was cut short and even the class now the schools have slowed down to the in order to follow the proper procedures and they are not getting the clinical skills that they would normally get so what we're trying to really promote is this whole idea of mentorship and like you said many of these docs especially and maybe some smaller markets are saying I’m done i don't want to go back to the office full-time I’m i just don't want to deal with this anymore and I’m ready to sell so why not explore some new options for this group why not explore the options of true mentorship where the doctor the owner is maybe backing away and they're backing away at an accelerated rate and that younger doc is coming in and really taking over the entire practice but it's a delayed sale opportunity where maybe the sale doesn't happen for about two years it really is the best of both worlds as long as both the incoming doctor and the owner doctor are really prepared to follow this through all the way to the end and that's again one of the things that we really emphasize here at ada practice transitions and that is spell out everything in the beginning make sure that your ultimate goals are in alignment so that you can lay them out very clearly and on paper and then follow through that is why i asked you to come on the show you didn't ask me um because um the ada um has a practice transition and where i first became known of it uh was your article that i posted on dentaltown what went wrong my transition fell through after months of planning by susan Ebert vice president dental practice and relationship management um so for my homies who are the lucky ones are just commuting to work for an hour uh the poor bastards are on a treadmill right now so uh um try to distract him so they don't realize they're on a treadmill for an hour they can't read this but tell them about your blog what went wrong um how did your transition fall through after months of planning and why did this motivate you to go help the ada start this um ada practice transitions well there are a number of what what went wrongs out there unfortunately i have my own personal what went wrong and then we have the one that you're referencing i believe in the blog post and that is where a an incoming doctor or potential buyer was looking at a certain practice they really wanted this practice and the owner didn't quite have everything in order so for about six months this owner was trying to pull information from his accountant and from his books and all of this is going on right before the pandemic hit the incoming doctor potential buyer got cold feet is really what ended up happening and thought that the practice now it's not well run [Music] it's not got what it takes to support them in their ultimate goal of you know personal and financial success and it just didn't work out could this have been avoided absolutely if the owner had had all of that paperwork in order ready to hand off to that potential buyer in a nice little package said okay here you go that would have made this thing much easier the financing would have gone through a lot faster and everybody would have had a successful transition so again one of the things that we really emphasize and let me just say this did this was not with one of my clients because what we emphasize is here's your list of documents you need to get in order have them ready have them ready to pass off make sure that you're entirely ready for your transition whether you are an owner or you are a potential buyer if you're a potential buyer make sure your financing is lined up make sure that you know exactly what you can and cannot afford make sure that your personal finances are 100 percent solid make sure that you know what your credit score is talk to the banks first hand make sure that you have a couple of different banks that you're working with find the best deal all of those things are so important to making sure that your transition is successful you know i i don't want to be that guy um i i never forget when i watch the uh the the movie documentary whatever on sesame street the two most famous characters are big bird and oscar the grouch and and i you know i had four kids watch all this turns out you know it was by the same guy and he ruled sesame street forever then got beaten out by elmo later on the little red one and um guess why oscar the grouch was so popular guess why kids love oscar i mean it's a guy living in a trash can in fact they um rejected the idea at first they said we can't have a man living in a trash can this is that's not right but guess who it reminded him of their grandpa some old grouchy guy and during this last election how many how many times did some two-year-old watch his grandpa yelling at the tv whether he was for this team or that team i don't be that guy but I’m that guy i mean my four kids have turned into six grandkids and i just think it was so much better in the 80s when if you bought a practice the seller would finance i mean um the it was it was like his baby um you you wouldn't just give your baby up to the highest bidder and then leave and never hear but your baby i mean he built this practice his own hands or his patience he wanted a good guy and um you would go in there and he'd say okay i'll sell it to you for this uh seven years uh terms ten percent interest and um and then that dennis that bought the practice it's really great because the guy selling has skin in the game so when he's working on a patient and he says oh my god i really messed up on this patient uh mrs Ebert and uh she's really mad then he would call you and he had a relationship with you it was just much better and now it's through a third person banker and it's like just take the money and run um i i just i just think it should go back to that way but um that's not the way it is and i know I’m oscar the grouch and i need to just shut the hell up but does the ada um practice transitions do you have a bank source that you can always that they can default to if they don't have a personal banker no one's uh one wants to do the deal can if they go through you can you always find them a banker that will do it we can most certainly point them in the right direction and help them to understand what the terms are and we can also give them the incoming doctors a kind of a list a go-to list of things that they need to have in order before they start this process but i'd like to go back to your previous comment mr oscar the grouch because i don't know if oscar had a wife but i might be that wife I’m not sure um do you like cookies absolutely and i love baking them for my grandchildren i must say yeah let me just tell you that what we want to do is bring some more of that idea of having the dentists be participants active participants in this process that's what we want that's our ultimate goal we want our docs to talk to each other we want them to have an open dialogue about what their futures hold whether you're retiring or whether you're buying a practice you need to be able to provide continuity of care for those patients and i think more and more now than ever if a practice is going to be successful there has to be that compatible philosophy of care that's transferred from the owner to the buyer or the buyer the owner it has to be compatible everybody has to be able to work towards the ultimate goal of providing a great experience for those patients and that's what makes a successful transition when I’m talking about personal and financial success I’m talking about it for both docs I’m talking about it for the owner doc who can transfer out of that practice and understand that their patients and their staff and their communities are going to be taken care of because as you said this is their legacy it's their baby sometimes it's a family legacy where their grandfather their father started the practice for the incoming doctor the new buyer i mean come on they have to be able to relate to that staff they have to be able to relate to those patients and if they can continue to provide a great experience or at least a consistent experience for those patients the patients are going to stay and that has to be something that that needs to be taken into consideration this going through a third party where you just meet at the end of the when you sign the contracts to me is ridiculous there's no place for that in dentistry we are a relationship driven business and we need to make sure that we're taking our patients considerations into account um i don't um i know uh uh these are challenging times but you you talked in your um in your own bios is dr eber considers herself a clinical dentist first and is unwavering in her desire to protect private practice dentistry and um the ada just like your parents i mean you can't win or lose when the kid's upset and crying and hurt and when this pandemic broke out the first thing i told the president of the ada is a trust me you're going to be the whipping boy for this i mean they're you know when you when dennis closed down for two months they're not happy and when they're not happy they don't think of the nicest sweetest things to say about their their parents their mom and dad you know you've all seen that in your own family um so um but how how can you say that uh and your desire to protect private practice dentistry if the fastest growing format in dentistry is dsos in fact of those um we had five thousand help wanted ads and um it dropped down to one thousand it was only dsos and and um i i think this pandemic has been the best thing for the brand of dsos um because a lot of dentists just didn't want to fight a pandemic head-on and it and I’m in Arizona which is ground zero for dsos because governor ducey uh passed a law that if you got an active license anywhere in the united states it's good in Arizona and it was actually triggered because of registered nurses they were actually recruiting in ireland and it was easier to get an irish nurse a green card and fly her to Arizona to become a registered nurse and to find one in oklahoma who didn't want to pass the boards whatever whatever but 18.6 of Arizona dennis worked for dso and then yesterday out of nowhere bob fontana of aspen dental management just acquired clear choice i mean the these guys are just a steamroller but um is it politically correct or incorrect for you to say that you are like me where you um you know i want my grandchildren to go to a dentist and that dentist is working for an insurance company and some mba is telling them that he can do this or can't do that then my granddaughter needs a dentist and she goes to another dentist and it's owned by wall street and they want profit dollars i mean where's my grandchild gonna go when she needs a dentist I’m not talking about the for my four grandchildren that are boys I’m talking about my girls um evelyn and um you know where's evelyn and taylor gonna go if all the dentists um sold out their means of production they no longer can work with their hands and by the way every time there's an economic downturn the the people that come out on top are always the ones that owns their means of production because if there's runaway inflation because of your 23 trillion dollars of debt they just raise their prices but you know who's first to go is extra employees when their sales go down so when you sell out your means of production and go become an employee that's all great when everything's good but trust me when things are bad you want to own your means of production but I’m just wondering how that works in the ada who like say during a pandemic they're not going to be able to do anything right but how are you allowed to support unwavering support for private practice when the fastest growing business model is dso well we can find places for these dentists to go number one let's think about some of the smaller markets let's talk about those for a second the dsos aren't going to the smaller towns great point they they're not rural no absolutely not they're not going there and think about how great some of those practices are you have patients who want to be there because you're potentially the only dentist in town you have a very low purchase price from an existing doctor who's selling the practice what does that equal to gosh you have a payback on that loan sometimes as little as a year and a half to two years and you can be the full owner no debt on that practice you have a lower cost of living in those smaller towns you can live like a king or a queen and guess what if you want to travel you can travel even if you're not next to a major airport go buy a plane because you have in many cases unlimited income potential in those smaller towns so let's talk about all of those small town dentists who are out there and the wonderful opportunity that exists for some of these docs who are sick of the hustle and bustle and the marketing costs that are involved with trying to stay afloat in some of these larger markets in the urban areas let's talk about the way how nice it is to raise a family in an area where you don't have to worry about them walking outside the door think about all those advantages there's a wonderful opportunity out there for these younger docs if they would just open their minds to exploring them that was that was brilliant you you two shade me if there ever was a touche on this show you two shade me because it's obvious they they will not go to rural so that's where half of america lives i mean i was born in Wichita Kansas um you know I’m I’m familiar with uh the flyover states uh you know you watch the news and everything only happens on the coast right and um in fact over here in Arizona we're so jealous of Florida i mean we're the Florida of the west how come no one ever talks about Arizona we're just as crazy as Florida which by the way only seems crazy because they have the only transparent criminal justice data so all journalists can mine their data where other states they can't mine that data but yeah they're not going to rule because the millennials um you know they they're getting married a decade later than they were in 1940s you know it's gone from you know basically um you know like 16 to 17 all the way to 26 27 they're single they have they like their their starbucks and mochas and whatever they do and they're not going to rule and these dsos i mean you go back 10 years a lot of them um you know that had by time they got to 500 offices on any given day they could have 20 rural practices not staffed with a dentist and they're done and uh so so you're right so half of america you just said brilliantly is never gonna go dso and then the um the the other half living in the metro um they're certainly not gonna take over the whole market so uh um independent practice has the uh the advantage but i was but i was wondering um about this about another question about the ada um this space was really branded um you know 50 years ago i don't want to say 50 years ago i don't want to make allen f thornberg feel too uh too old but al you know afco and associates afco stands for alan f thornberg and he started this a gazillion years ago and he had a model that was very efficient but the lawyers didn't like and that was he didn't want to have two lawyers fighting over the price so he said look we're going to get this done we're going to have his lawyer represent both parties and get it done of course every attorney will tell you well then who's representing you you have to have the lawyer representing you and alan was like forget it you know you can't get two dentists to agree on anything you can't get two dentists to agree on a bonding agent uh how the hell are you gonna get them to uh agree on financial terms um but what i what makes me wonder is we know how alan started it dual representation let's get her done so what was the ada um what did you think what did you guys have that you thought was so unique to practice transitions and valuation and this deal where you thought um you um guys at the ada could um have a unique valuable approach to this how were you seeing it well one of the most important things is that we're approaching this a little bit differently instead of talking first about the valuation what we're talking about first is are the dentists compatible and I’ve talked about that a little bit before but that's where we start we start with is this the right place for you if it's the right place then let's start talking about the other details that go into it so we start with an online profile it's pretty extensive and we've been called the for dennis I’m kind of sort of okay with that but i prefer master matchmakers because we behind the scenes go through and match up these profiles and we match them up based on the philosophy of care so we only put together dentists who have the ability to communicate with each other and then we act as facilitators for that conversation we're not negotiating for the dentist we expect and this is what i talked about earlier we expect the dentist to take ownership of this process because then it's going to be successful we found that most of our owner docs wanted to con they want somebody who's going to continue their legacy that's what they want so they have to be involved in the process if they want to have success there so we give the dentists very concrete things to discuss we give them tool kits and worksheets and guides discussion guides and we're there as facilitators for that conversation so they may not be able to agree on to on the bonding agent and that's okay but you know what they're having no problem really agreeing on the purchase price they're not having a problem agreeing how to handle the accounts receivable they're not having that problem because they already have a relationship with each other because another thing about dentists is they're not very confrontational and that actually works to our advantage you you think dentists aren't very confrontational dentists are confrontational in certain situations but in the one-on-one they're generally not yeah one-on-one i i love them but my god when when it's 11 o'clock at night and they're drinking and they're behind a screen and they don't have that 100 million years of bio biological evolution where you know you have more muscles in your face than you do below you know your your hips and core i mean um i mean that's why emojis became so serious because you know if the person was joking or this that the typos go up on dental town i can just read the post and tell you uh was this early morning sober on coffee or was this drunk bastard 11 o'clock you know barking at the moon and the typos go off the deal so um that is the weird thing about social media people you know they forget that there's a human being sitting on the other side and what's funny is um and yeah and i'll i'll call dennis on their own any day of the week um because I’m not here to be their friend I’m the hair to be their grandfather to tell them you know this is real world but um my gosh they on dental town when they get a bad yelp review they almost have a complete meltdown you know it's like you have to walk them off the ledges like dude three posts to go you said this company's product was a bunch of i mean i mean my you know what what's with that how come when this patient said this you're you almost jump out the window but then you just called a dental company a piece of i mean you know so um i still think we're evolving through this social media thing and and it just really really helps i i wish everybody at dental town would be transparent and put their real name in face um the only reason we can't do that is because the mother of uh my mother of dentistry is rolla christian and she uh scornly told me Howard if you do that where are my dentists gonna go when they need to ask a stupid question if you're an endodontist you're not gonna post a failed root canal in front of all your referrals they'll be held again she goes if you take away their place to privately ask a stupid question um you're you're it's a disservice dentistry so uh you know and since rolla will probably outlive me by a decade with all that good clean living um um that's the way it is but they they just um dentists are great in the face and but behind the monitor sometimes they need to be taken out to the woodshed um you know um it's just uh crazy times but um so the the match mate um that profile um i I’ve seen that on the ada deal so if you so her website is ada and you uh create a free profile um i can't actually create a profile because the last one i filled out was on plenty of fish and i got denied they said dude you're a whale get the hell off of here or lose 50 pounds uh so i'll have all this trauma if i fill out a new profile again but um the ones I’ve seen go south this is where the ones I’ve seen go south um i mean in a nutshell um doctor presents all these amazing cases and he's he's you know every friday he's doing some big five ten twenty thousand dollar case or whatever and the new guy looks at the big case and says well i can do all that skill oh yeah sure you can but can you sell it it's a hundred times harder to sell a 25 000 case than it is to do all the individual crowns and bridges and root canals and all that kind of stuff they can't sell it so they'll buy some practice that's uh doing like 1.4 and they'll pay like 1.2 and at the end of the first year that thing didn't even do 800 so i mean so they didn't have the skill set so then what's the opposite of that or they'll buy a practice where doc did all of his own molar endo at a thousand bucks a piece but doc doesn't like endo well did you back out every damn root canal out of the sales equity did you just pay for the right to do root canals when you're going to refer them out so then you flip that around where's the biggest value i mean mike nattola and i used to laugh her butts off forever of how this one of our friends bought this practice from this old guy all he did was amalgams he didn't do crown he just patched everything those young didn't even know it just walks into this four day a week practice from the 70 some year old guy selling who'd made all these modbls for like 40 years and on any given random day three or four of those would just break into a million pieces and come in and he would just numb them up and do a crown and he was doing four crowns every single day monday through thursday unlimited and i was just like my god i mean and he paid this practice i mean um when you know the average price right now is about 7.50 but back in the day um this this was like a 285 000 practice it's just a a no-nothing bottom tier practice and it was just the biggest cash cow of all time and that's what you need to do so you go find a practice and he says i do a dollar a year and then you look at the numbers and say oh well you refer out all your root canals which i can do or or i can extract teeth or i can do dentures or I’m going to add invisalign or something so if you're make sure you're paying for dental services that you can do and don't be buying the right to do dental services that you can't do i mean it's just so obvious um but since the buyer didn't have skin in the game he didn't care he took the money and run and i i just you know i just don't think it's right well that's one of the reasons that we have a full clinical evaluation sheet so we encourage the docs and look at the charts we as part of the profile we actually ask about referral patterns and that's one of the first things that we look at when we're saying is this going to be a good fit and often what we're looking for is a an incoming doctor who can provide services that the owner doc isn't now providing um and we absolutely have a nice little checklist you know that advises the incoming doctor how to evaluate the operations of the practice and then they can take that and put that into their own skill set and figure out whether this is something that's going to work for them obviously if a practice is doing 40 iv sedations and this incoming doctor is not doing iv sedations that's going to be an instant hit to the bottom line so that's one of those big red flags that pops up hey have you thought about this let's take a closer look and see if this is the right place for you now we can evaluate a lot of that behind the scenes so we can immediately discount some of those things and say hey you know you might want to take a look at this practice but here are the things that you're going to want to evaluate a little bit more closely to see if this is the right place for you if everything else is lining up properly again it comes back to these doctors communicating and really taking the time to evaluate first is it is the philosophy right does that work out yes great now let's talk about the operations of the practice before we invest a whole ton of money in accountants and lawyers and everything else let's just find out whether the operations fit and i can come in and be successful in your practice if i can yes now i want to see all the numbers i need to make sure that i have all the information that i need so that i can make an offer on your practice so guiding them through this process will alleviate a lot of those things that you're talking about so how much of this i mean um you know i i just i look at it as like having a dental partner buying a practice i mean the the best analogy is your parents marriage your marriage things like that you know you don't you don't go meet somebody on a first date and marry them uh and um but um you know um so what percent of these again my main concern does these kids come out of school how many of these kids out of school how long would be a dating period if they said well i want to own own practice and i fill out a profile and and yeah i would like to really think about buying this whole man's practice in this small town in Kansas um but but i don't want to commit to anything like that i mean how have you met you i want to date how long um is that a good strategy to get an associate's job and how long would a dating period be before um the seller and um said you know let's kind of start writing a prenuptial you know what i mean let's let's start heading down the road towards marriage yeah that prenup needs to be in place fairly quickly because what we don't want to see happen and this is what we see happen all too often is the associate comes into the practice with the understanding that there's going to be a transfer of ownership okay now this doesn't work and this can work in either direction the owner then decides that hey you know what i kind of like the way things are going yeah you will will do an ownership transfer in a couple of years yeah i think I’m going to retire next year maybe the year after that maybe the year after that all of a sudden it's 10 years down the road so that's one scenario the other scenario is the associate comes in the owner thinks that yeah we're going to transfer ownership and I’m going to retire in three years or five years but then the associate says hey i kind of like being an associate in this practice i don't think i want to own now the owner says i don't know what to do I’m I’m high and dry i was counting on this so what we encourage people to do is consider all of these things up front and again we're talking about understanding your long-term goals and by understanding what you're looking for out of your transition you can help to avoid a lot of these problems but if you don't get it in writing and plan for the future in writing then you are just opening yourself up to one of these scenarios so we encourage people as an associate coming into a practice especially a new grad we have the conversation up front and say okay dr owner what are your plans here are you willing to put those plans in writing you're not committing to anything you're just putting your plans in writing doctor incoming are you looking to eventually have ownership in this practice do can you see yourself in that practice if those two things are a yes and they've met and they've evaluated operations and they've made the decision that yes we want to give this a try great let's drop an associateship contract within that contract let's have a six month review clause at that six month period you're going to talk again about this whole ownership thing and at one year in you want to make a decision and that decision has to be dr incoming are you going to buy this practice if you are here's how we're going to lay it out we're either going to do a staged buy-in or we're going to complete buy-in and then I’m going to be your associate there are a number of different options at that point but make that decision and put it in writing and then when it is in writing after that one year make sure that there are there's a penalty for an exit at that point well you know it may not ever come into play but if it does at least you have it you know i grew up on judge wapner and uh I’m sure you remember uh judge wapner and i don't know how you could grow up listening to judge wapner not have your damn receipt i mean people would always say something well blah blah blah blah okay show me your receipt i didn't keep my receipt i mean i mean in fact watching judge wapner in my glove box i used to just that was just a trash can for receipts and sure enough you know once a year you'd have to go dig through all that trash because you actually needed a damn receipt and so you know you go talk to a dentist and you're at lunch and at dinner and he says he wants to sell next year and then like say it goes to next year the next year the next year and what i think is that um people don't understand how much money it takes to retire to maintain a doctor's uh lifestyle and when they get close to pulling the trigger and they think well my car's old and the wife wants to do this and we want you and then they're kids might need something and one thing um about life after another and it just they just keep kicking the can down the road um is that more that and you also talked about the associate who doesn't want to pull the trigger works is it more is it 80 20 is it 50 50 do you see more sellers staying on longer than they realized or do you see more kids not wanting to pull the trigger i would say that it's 60 40 towards the owners 60 40 toward gianna okay towards the owners being being the problem there um yeah the owners are that they can be a little bit challenging sometimes because they're not sure what to do and what we do for them is we make sure from the outset that we've had a conversation to say hey you know have you really thought this all the way through what are your plans for retirement do you have the financial wherewithal to continue down this path now have you explored other options i mean once you've retired from your dental practice there are other ways to stay involved in dentistry and make some money there are so many other options out there do you want to stay on as an associate to the owner the new owner that's always an option so there are ways to navigate this but every single doctor has their own agenda and it's our job to figure out what that agenda is and again i think that's where our profile has a lot of value it helps people to start thinking about what really are my long-term goals how can i achieve them in the way that makes the most sense yeah and um my gosh this um the these um financing terms when i talk to bankers they say well one of their problems is they had all these rules of thumb they had all these metrics and these metrics are actually written down in their banks and and they um they um you know based on the purchase practice it's a trailing 12 months but you've been closed you were closed down two months and that's a big donut i mean two months out of 12 i mean if you just say 2 divided by 12 hell you were close 16.666 percent of the the month so a lot of these bankers are kicking the uh these loans upstairs and saying well I’m good with this loan i want to go everybody wants to pull the trigger but our bank has this metric and it's not accounting for two donuts in the month of march and april and now that march and april um is now seven eight months ago is that starting to change are they getting new metrics are you seeing some of these deals starting to break loose from um the um uh what do you what do they call the lone guys uh the the banker at the line the underwriters the underwriters and the underwriters um they're like actuaries they don't have enough personality to become an accountant i mean these people are numbers driven um so are the underwriters um are they do they got some post corona metrics now are they still pre corona yeah they're still trying to figure that out so that has absolutely been a challenge which is why we're encouraging our owners to go back and start considering taking on a seller note at least for a small percentage of the loan dental offices are back to about 78 percent at this point maybe close to closer to 80 from the latest data latest research that came out so we're getting there we're getting back to 100 i don't know how long it's going to be before we get there so that by itself is reducing the bank's uh tolerance to loan 100 of the practice value so if the owner is kind of dead set this is my number and I’m not budging on it then they may have to start being more willing to do some seller assist on the financing and that's something that we're just having to make real really very clear and I’m gonna go back and just kind of let you in on this the smaller market practices are doing much better overall at least from what i can see they are now hiring associates again they are at 100 production and they're doing just fine oh yeah but but i mean i i know I’m supposed to be politically correct not talk about uh sex violence rock and roll that kind of stuff but uh it seems like the only people that will go to a small town is when they come out of school and they're married if you've already got your wife and your kid you don't need the bar scene in scottsdale and my gosh and who usually comes out of dental school most likely married with one kid walking and one in the oven i you know i don't want to okay i i started dental school with two children so really well tell us about that journey how so really my kids were one and two when i started dental school yes sir and i had owned a business prior to my starting dental school um yeah that was that was a journey so they were one in two went through four years of dental school so they were five and six when i graduated which is why when i graduated i looked at my husband and i said okay we're in Louisville kentucky which is kind of gray in the winter and i said we're either gonna go north where winter is winter or we're gonna go south where we don't have to worry about it he says there's no way we're going up north i said okay guess we're going south so that's how i ended up in Florida yeah and it's that mississippi river is uh everybody east of it goes to Florida and everyone west of it goes to Arizona i mean it's just i mean and you need to realize human behavior because something like that you just think uh whatever it's not really a deal no it's really a deal and like when i I’ve been in awatuki for 32 years and you have an interstate and there's a whole another city on the other side and people just i mean that interstate it might as well be a wall a hundred miles high when you look at your data of your patients in fact they'll drive from five miles west into my practice and almost no one drives from one mile east into the practice humans don't cross rivers and interstates and and all these things and and you really gotta get into that um i want to ask you um two politically incorrect questions um some people say and and i i have no expertise to comment on this even though i grew up with five sisters and played barbie dolls i was 12 that that one of the things um changing uh in dentistry the most is the demographics from basically being an all-boys club to now half women and a half boys and a lot of people are saying that is driving um the dsos because two third two out of every three of their employee dentists are female you're a female do you think um women are more likely to want to say i'd rather just be an employee and concentrate on my family or do you think that's just a um a bad rap i think that's a bad rap for a number of reasons number one if you want to be a hands-on mother if you want to be there for your child at their at their uh goodness it was a mommy and me tea tasting party if you want to be there last minute for your kids you need to own your own practice you need to have the ability to control your own schedule you can grow that practice in whatever direction you want you take the reins you take ownership of it most of the dentists who graduate from dental school are still interested in ownership and that's like 64 i believe at the last check oh i haven't seen any numbers on that where'd you get that number uh from hpi oh well will you email it to me Howard at or or i I’ve not seen that number but so I’m saying that's two out of three women are you talking about women or total students I’m talking about total students but the class sizes are 50 50. yeah so i just know from my experience and talking with female dentists i will tell you a lot of them go into it with the idea that okay i can't own my own practice because i want to be a hands-on mother i want to be a hands-on wife i want to have that opportunity what i see is that i have more and more women coming on to our service who are saying i need to own my own practice because i want to be a hands-on mother i want to have that opportunity to be there for my family and i want to have control over how i treat my patients so women i i have to disagree with you about your uh feeling or your thought that women are not interested in ownership it's not been my experience and it certainly isn't consistent with the dentist that I’ve been talking to on a very regular basis that that's awesome i i love to see it when women own their own practice i actually love it the most when they uh get divorced and have to pay some punk eight thousand dollars a month alimony for 10 years I’m like how how does that feel you like that huh it's so awesome to see women dennis just bitching about alimony it's like yeah i know it's a racket why don't you get rid of it used to be out an all-male's thing and I’m just loving these women to if you're paying ten thousand dollars a month to some bum uh email me Howard attend and i'll bring you on the show and talk about it because it because that that's what's going to make everybody change um it is a total total racket um but um yeah i i go back to my class there are 20 women dentists there those 20 women their average practice was significantly bigger and more successful and those girls pretty much all them are already retired now and i got a lot of classmates that are really pissed off that they passed 60 and now they're in a pandemic and they that they can't retire mostly because of alimony and things like that and uh i am i just think um uh these are strange times i want to ask you another very very politically incorrect question i i told you in the beginning that um um that when your uh kids are in a bad spot um they're not going to be real friendly they're they're they're in a bad mood their kids are tired they need a nap they they need a better situation and there's a big old threat on dental towns that uh uh quit the ada and it's all based on the fact that um you know they that we had to close down for two months and you know um it was a novel virus that's what all the experts were saying you know we had a we're all in this together one species um is all we got but what's your spin on all those people that are really pissed off and by the way those people were extremely happy uh when um it was the um joshua tran osofsky DMD president of new hampshire dental society said dennis closed their door for two months in march and they won't do it again and everybody's on downtown go yeah joshua you go joshua so the new hampshire dental site i mean they're they're in the press i mean it was on it was on their their newspaper so the new hampshire's saying they're they're they're not doing it again what's gonna happen if the government uh well first of all do you think we'll talk about the issue just talk about the whole issue because it's a big it's a big blight and um it is and it's really too bad well i take that back maybe it's not too bad dennis are giving the american dental association way more credit for being able to establish federal policy than they deserve the ada did not shut down dental offices that is not the way this works the states shut down the dental offices there were some states that never shut down the dental offices when what the ada did is what they they went to bat and said hey these are essential workers the ada is the one who who lobbied to get dennis designated as essential workers so now that they are essential workers they can't be shut down unless the state says essential workers are shut down which they're not going to do so the ada is trying to protect the dentist and doing whatever they can to do that i have i admit freely i was one of those people who sat in my office for 11 years 13 years paid my dental and paid my dental association dues didn't have any clue what the american dental association did for me just paid my dues i was one of those people after i sold my practice and i had to due to some health things health issues i went to work at a federally qualified health center because i really love dentistry and i really have a passion for serving people and everybody deserves to have access to dental care at that point i started getting involved with the dental association i started getting involved in lobbying i started get i started seeing the things that they actually did and i was very impressed i was impressed enough to spend a lot of time with the Florida dental association and by the way i have to have that shout out to Caesar too way to go but come on the american dental association did not shut dentistry down the american dental association did everything they could to get dennis back up and running they gave them they talked to the national leadership and said hey you know let's get policies in place so that you feel comfortable in your state allowing these dentists to come back to work the american dental association did everything they could and they had to be conscious of the climate as it existed in that moment nobody knew what to do in those first couple of months they did the best they could um that is a um well well well said i mean uh yeah they um that and and furthermore it was the centers for disease control uh that floated the idea first the the centers for disease control uh wanted uh to go in the end and the the world health organization and and again it was a novel virus i mean it was a brand new virus so um people didn't really uh um know what to do and uh but do you think there's um um i i saw um but i love the irony of dennis i mean um gordon was always telling me about that um he said my gosh you know i remember one time he was out here in scottsdale i had like 500 or a thousand people and he was showing this case i think was about it in clear liners and immediately the whole room wanted um thought the four bicuspid extraction was an atrocity and the occlusion and then and everything he was trying to teach just drifted in a whole nother direction because my homies all got eight years of college i mean they got a's in math applied math is physics applied physics is biology chemistry applied chemistry's biology i mean they got their masters and all the tools to tackle any subject and like in this mask thing i i thought i i was talking to i said well why would you be against a mask policy and he says because if they want to force me to wear a mask dude cigarettes kill 400 000 americans a year you you stop selling cigarettes all wear the mask but I’m not gonna wear a mask while that dummy over there is smoking a cigarette so you know and I’m thought god that's just that's the way dentists think i mean obviously tobacco is to kill more people during the pandemic in america than than the coronavirus i mean can we agree on that yeah so so i have to wear a mask inside a store that sells cigarettes really so you know so and but then the the opposite side of that is never let better be the enemy never let best be the enemy of better so yeah um but making them wear a mask could you imagine if you took their tobacco away you're in Florida what would happen to Florida if there was no skull chewing tobacco to be sold uh anywhere in the state of Florida or even worse think about kentucky oh it'd be it'd be an uprising right i mean they would march to the capitol and it'd be over so i love the way uh dentists think about this stuff um but um i i think um i really think uh I’ve been a big I’ve been watching the emergency room numbers ever since I’ve uh the day has been available that eight and a half percent of all the toothaches are emergency room visits or odontogenic origin in my state of Arizona and my gosh um it just makes me feel bad i mean what is wrong with dentistry where we're responsible for not triaging and taking care of eight and a half percent of the load at the um hospitals and by the way in 32 years I’ve seen some bizarre stuff i had a patient one time walk in with a two foot by one and a half foot x-ray of the side and a script for pen vk and percocet because of a swelling and infection I’m like they just irradiated your whole upper torso i mean it was just crazy but uh so if the pandemic breaks out and the hospitals are overloaded you would have to be insane to even think about shutting down the dental offices if you knew they would triage and keep patients at the emergency room but they have no history of that i mean i got 10 years of data in Arizona where i mean if you said well we got to keep them open because we want to overload the emergency rooms like dude you've been doing it for 10 years what's going to all of a sudden make you start giving your cell phone number to your patients and um and being able to uh go in after hours or their their cl hell they're closed friday saturday and sunday they're closed three out of seven weeks in fact the average dentist is only open 32 hours a week and there's 168 hours in a week they're not even open they're closed 81 of the time and the emergency room is always open so how do you how do you look at that scenario it's funny that you should bring up er diversion it was one of the things that i was pretty passionate about here in uh Florida when i was the dental director for the fqhc and i will tell you that after beating my head against a brick wall for a very long number of years we finally got the hospital to give us a voucher system for we got a hundred dollars from the hospital for the patients that we would see from the emergency room we ended up oh gosh i wish i had all of the data in front of me but we saved the hospital in one year over five hundred thousand dollars just by seeing their patients for them and giving them the opportunity to come to one of the federally qualified health centers that's kind of an easy answer but why are the real problem is the hospitals aren't recognizing that the dentists need to be their partners in this there are a number of dentists like me out there who went into who have been beating their heads against a brick wall uh jane grover is kind of the head of that whole thing over at the ada the er diversion programs and she's got so many different plans to be able to handle some of that overload and it's the hospitals that are really kind of the hold up there the dentists are more than willing to be active participants in this well hey tell jane i I’m sure once come on the show and talk about it i wish you'd talk about because you would have to be absolutely out of your mind to think that the 10-year track record of it being eight and a half percent that human behavior doesn't change like that overnight it's like it's like when they started the no smoking campaign i mean and when they started it i mean america um the government started this problem when they started giving uh six million troops overseas they started rashing him a pack a day well when they came back from world war ii guess what they were addicted to nicotine so to me when the government sued them and wanted you know this lawsuit's like dude you started the whole smoking epidemic and based on the fact that the journalist is just and there's no journalism in the united states i mean uh read non chomsky's book manufacturing cassette um it's been when they say they're um not biased i mean come on let someone say oh sue noone's not biased really they all cry they all start bawling on tv when a democrat loses and they're not biased how out of your flipping mind are you i mean i mean i mean they they can't even compose themselves they they're ball i mean if you're a journalist bawling on television quit your job today because i don't want to get to know you or your i just want to know the facts the government started the deal i watched this with ge you know where all these lawyers were wanting to sue ge for all these chemicals dumped in the river well they were all made during world war ii and there's a ton of letters written to the president of the united states and the five-star general saying well if we make all this stuff what are we gonna do with this and there it is in the letter just dump it in the potamic you're in the middle of a war you're getting bombed from hiroshima to you know i mean to knock a socket i mean it's a horrible thing going on and no one was caring about the tadpoles and the potamic at that time uh so it's a nice luxury 50 years later uh to sit there and say well we want you to clean it all up and all this stuff that people are complex these are very very strange times i can't believe uh we went over an hour but yeah i'd like to have jane grover on if she's head of the um diversion the american dental associates because we're still going to have this problem in 10 years because i know my homies say they're they're closed friday saturday and sunday they specifically did not want to be a physician at a hospital and work those hours i mean how california had to pass a law that medical doctor residencies could not work over a hundred hours a week because they were falling asleep during surgery have you ever even heard of one dentist since pierre fuschard that ever worked 100 hours in one week yeah california has to write a law to ban that with physicians my homies uh they went to the medical school country club dentistry thing and they're not working evenings and weekends and if i was gonna start um a dso i have been in small towns i have walked into the urgent care uh I’ve walked in there with my grandchildren and i talked to the guy in about this problem he says yeah there i said well what if some dentist came out of school and um would you give him some space for free for him to set up a dental office so that at your triage you say oh that's dental related just go down the hall at the last door and turn left and he said hell yes and I’ve had other dentists that um couldn't get a loan or whatever they go into small towns like i think 11 of the towns in the midwest do not even have a dentist and they've actually gone to the mayor of that town the mayor of the town says well at downtown first street in maine we only have one light in this town there's six buildings boarded up i'll give you a damn building and if you're gonna set up a dental office there we only have one bank in town he'll give you a signature loan and the only people that do it um how i don't know how i can politically correct say this but they're mormon they're lds they have a family they already have kids they go to that small town they're the only dentist in that town they get a building for free they get all they get a signature loan and the first year they're they're doing a million two taking home 400. everybody in that town thinks ten dollars an hour is the best job in the world so as labor's only always uh below 20 total cost their net income is always over 50 percent but i get it some people say well i'd rather die than live in a town but you're almost to driverless cars i mean I’m in phoenix where google did their their pilot work for five years we've had the driverless cars we've all seen them and humans are so funny one of the biggest episodes they had the problems they had is people throwing rocks at them because you know you know you know my monkeys they they don't they don't like a car without a driver scared them and they're throwing rocks at them and all the parts down but and and then what's another thing that's totally irrational um because when you're talking about something irrational it's irrational like a lot of people say well um well let's say there is a thousand people dying a day you wouldn't close down the country for 1 000 people a day if there's 335 million i said well look at look at plane flying i mean i mean last year like only one guy died in a commercial airflow it was on a southwest airlines flight a little piece fall off the engine cracked the window and sucked his head out most humans like me just compensated we just said all right i don't want a window seat i'll just move to the aisle aisle row i mean big deal or just set it in front of the wing i mean problem solved but imagine if two fully loaded jumbo jets were falling out of the sky every day in america and killed the same number of thousand but my my humans my homo sapiens my monkeys who lost their tail saw two jumbo jets follow skye every day how long do you think it'd take him to close down all the airports eight seconds so when so if they don't see it firsthand if they can't feel it and sense it they just don't get it but I’m telling you if i was gonna start a dso it'd be emergency room dso and i and and every hospital I’ve talked to their their um it's just culture why can they remove a tumor out of your brain do a bypass and amputate your diabetic foot but they can't pull a first molar or do a root canal i mean it makes zero sense it's totally just culture and uh and by the way there is some lack of culture in Arizona i was um i was actually upset uh yesterday at walmart um a lady was wearing her christmas pajamas to walmart before thanksgiving you just don't do that you don't wear your christmas pajamas to walmart until after thanksgiving have some class Arizona my god um but um um one other thing i want to ask you about is um sometimes um the hardest thing to do with a human i mean satisfaction equals perception of what's happening minus what i expected and the hardest thing to do with a human is change your expectations and I’m trying to tell some of these kids i know you signed up for dental school your dream job all that kind of stuff but we're in the middle of a once a century pandemic maybe you should change your perception and get a job at a what do you call it fhq is that what they're called that you work qhc fqhc um talk about that that maybe there's other alternatives and maybe there's other things you can do right now during a once in a century pandemic that maybe you weren't thinking about when you signed up for dental school well there's a big perception there that public health dentistry is inferior that it's a poor working conditions there are a lot of perceptions out there when you say the words public health and i am going to admit to having had some of those perceptions let me tell you my practice was quite high-end and i most of my patients were the ceos and their wives in Ponte vedra beach when i went to the fqhc my commitment at that point and at that moment was i am going to give this population the exact same care that i gave to my ceos and my wives of the ceos and i am proud to say that i would pit the dentistry that was done during my tenure there and goes on today because i know who took it over i could put it against any dentist in the area because we paid attention to quality we had some of the advantages of working that in a public health you have set working hours there's little to no call you have a guaranteed paycheck you have the ability to provide care however you want to as long as you're in the right situation there are a number of fqhcs that give their dentist pretty much free reign to do dentistry however they want i was doing football reconstructions at the on homeless people the patients can are expected to pay a very small amount that small amount represents a huge chunk to them it's an opportunity to change the way people think about dentistry one of the most gratifying moments was when we finished with one young lady and she said my children since i started this process have brushed their teeth twice a day and lost every day since i started this and they now are in a habit because that happened it was took a long time to get the treatment completed they have habits now that they can take with them so we're changing the mindset of an entire population that's a pretty special thing and it's one heck of a of a moment for a dentist who just wants to help people so many opportunities exist out there like that don't discount those you have to search a little bit sometimes and you've got to find just the right situation for you and your needs but there's so many opportunities so i would encourage a lot of these younger dentists especially now who are really searching for something different changing their perception go look to public health there are a lot of advantages there and a lot of really great opportunities and i just want to say one thing about expectations i mean i totally love anthropology because the teeth last longest and they always have the most evidence is dental related i love anthropology but obviously all animals want their own nest i mean look at woodpeckers and they're beating his beaker into that tree because he wants safety wants his own hole and you let your i got four dogs you let them out in the morning they you know they go pee and mark their territory and this is their tree you know i i get that you want to own your own place and a lot of you want to go back to that um that small town and you want to own your own practice and you don't want to buy somebody else's okay i get it but there's this little thing you might not have heard about called wall street that is completely built on mergers and acquisitions which is why if you look at the 500 publicly traded companies in the year 2000 already um half of them don't even exist anymore they when i got out of high school the average age of the sv 500 was a grandfather it was over 60. uh now that I’m almost 60 on the average age of a fortune 500 company isn't even a teenager and by the time you're as old as me the the average company won't even be 10 years old and you go into this small town and you want to set up your own practice and there's some old guy selling so the town's got a thousand or 10 000 people and there's 10 dentists and this old guy is selling you want to build your own so now there was 10 you build your own now there's 11 and then old man sells to young kid and now you're competing with a high-energy uh dock in their 20s or 30s so that's just that's just not how wall street wouldn't would do it they would buy out that old man because now um you know it's gone from 10 and every time I’ve ever found and met a dentist collecting three or four million dollars it's only that strategy I’ve not seen another strategy well i came here there were eight dentists and about every five years some old guy retires and now this town's only got three dennis and of the um five that i bought almost all of them stayed part-time one day a week to sometimes two days a week and then something would happen in their life financially and they'd bump it up to four days a week and i mean they just own this town through mergers and acquisitions that's what that's why um bob fontana just bought clear choice because he didn't have to go set up you know a whole chain of implant centers across the nation um he just buys it and by the way um you know so this is going to go on for uh ever i just want to on dental town under practice transitions uh it's a real active part it's broken up into uh associates corner uh future planning life after dentistry partnerships and associates practice acquisitions practice sales practice startups retirement planning and then life after retired dentist form which by the way the most active dentists on dental town are the ones that retire because they they sold their practice but i mean they didn't own a restaurant i mean when you own a restaurant uh your personal identity isn't a baker but a dentist they they sell their dental office everybody still calls them docs they still go to the ce events i mean i cannot tell you how many times I’m lecturing and i find out the guy sitting in the front row sold his practice five years ago but he's a dentist so just final question i know we went into overtime and you got better things do than yak with me all day but for that old man that's um planning on selling his practice and retiring sooner rather than later um he's not on instagram he's not on snapchat and he wants a return on investment like in real estate it's a fact that if you go fix up your home in Arizona and put in a brand new swimming pool you're not going to get that swimming pool back out of the purchase price you lost money on the swimming pool and so doc's thinking well i you know i i would not want to invest a dollar fixing up this old thing to sell if i didn't at least get the dollar back at a bare minimum and it'd be nice maybe to get a buck and a quarter a buck and a half is there any advice you have to old senile dentists who are thinking about laying down their drill and retiring of what they could do to increase the value of their practice in the eyes of young millennials yes and i will make this short and sweet the one thing that the new generation of dentists seems to value as the number one indicator of whether they will or will not fit into a practice as far as the technology goes is digital radiography they all seem that that seems to be the number one determinant of whether they will even look at a practice it could have if you don't even have that then you better be in a really good area and you better have some kind of other draws that these docs can can look too you know that's so funny because my oldest grandchild uh turned 13 and he asked me one day what this room was for and i had to tell him it was a dark room and he said well what is the dark road i i had to explain to them how it started off we were dipping them in liquids and then when the at2000 came out and automated the dipping we were like man that was the greatest thing in the world i i still think the at-2000 was the greatest thing that ever happened to dentistry and um and the cbct is a bunch of crap compared to when the pano did that software upload and they put a r on the right side and the l on the left and all your patients could see the right and the left that's the only thing anybody can read like is that my right side hell yeah homie yeah i mean that so i'll i'll take the right left panel and the at2000 but um so you're saying digital radiography um i agree and um and you guys um all i want to say is this um at the end of the day you know uh pierre furchard you know was the first one that got the barber surgeons to give up cutting hair and let's do this teeth thing full time then a hundred years later we had gv black and then when i got out of school i actually met a dentist who practiced outside in st joe missouri and when i asked him what was the greatest thing about the great depression he said well you know um because he graduated in 27 i said oh man that must have sucked because 29 wasn't a good year and he goes well 29 wasn't a good year for wall street but we didn't know about that i mean that was wall street it took all the way till 32 to trickle down to the midwest and we we suffered the depression 32-36 but he says best damn thing happened to dentistry because um we could never afford to go inside but when everything went bankrupt and boarded up and closed up finally the mayor's like well just unboard these things and let these guys go inside hell it's winter outside and here's a boarded up building you can still do that today in 2020 every small town I’ve ever driven through has boarded up buildings and and and and what uh dr rue was telling me is that when they moved inside they all kind of had a pack amongst cells that they were going to give up the barber side they were just going to go in and do do straight stand up dentistry and you want to get your hair cut you can go somewhere else i mean so you know there's just think outside the box but the bottom line is i don't care if you're a dso private practice a dental insurance company a dental manufacture i don't care who you are you're a top line those are all the numerators and they're all divided by one denominator the patient and if you don't keep one eye on the patient and one iron cost then eight billion humans are not going to have the freedom to afford to go to the dentist and you only became a dentist to help your patient and the whole industry starts when a human gives a dentist a dollar to fix something in their mouth and it's all about the patient and I’m and the value chain works so well together at intel and motorola whenever you're dealing or talking with somebody higher up in another industry the whole value chain courts each other dates each other shares information everything they can because they know if they don't get out their computer faster better smaller cheaper higher quality they all lose and in dentistry it's all about the patient and i don't really care what doc thinks about a dso or delta dental or the ada i want to know do all your policies divided by the patient do they make dentistry faster better easier lower cost higher quality it's all about the patient and every dentist i know that keeps one eye on the patient and one iron cost and and drowns out all the noise from the dysfunctional value chain they they do very well in dentistry and uh on that note um thank you so much for coming on the show um if that jane grover who's uh a DMD and a mph uh a DDS master bubba girl if she can talk about um how dentists can do their job without having to rely on an emergency room who's really sick of our crap i mean go to an emergency and tell tell the head er guy you're a dentist and he'll roll his eyes so the next time you're whining well you know some people don't think dentists are real doctors well nobody in the emergency room thinks you're a real doctor i am going to I’m going to interrupt you Howard i haven't done that the entire time right on but I’m going to interrupt you because it's not the er docs they are more than willing to embrace us it's the c-suite guys they're the ones who aren't giving us the opportunities that we need to be able to have in order to come in and treat those patients it's the hospital administrators it's the insurance people they don't they don't see this as a value add enough i literally had a hospital administrator tell me yeah that's that's about eight percent that's not enough for us to invest that kind of money in this wow they are the ones when i went and talked with the er folks they're all about it oh yes let's do this let's do this let's do this when i go up and i talk to the hospital administrators and the ceos and then they get the insurance companies involved that's when things break down because they're fine to charge thirty thousand dollars literally saw a guy come in like you with a bill for thirty thousand dollars because he had to have a cat scan and a pet scan for an infected second molar so so you're saying it's the um it's the ceo the chief financial officer the chief operator the ceo the chief information authority you're saying all the c-suites people are saying i mean obviously um if you if eight and a half percent of americans i mean half of america goes to walmart in any given week uh or a month um if if half of america went to walmart and eight and a half percent of them wanted an item what's the chance walmart would carry it hundred percent and they'd make twelve and a half percent net income on it um so you're saying that that it's the uh c-suite uh hospital executives that don't um aren't doing this right that's been my experience and i did it for six and a half years pounding the pavement i went and i talked to legislators i talked to the ceos i talked to the hospital administrators i talked to the cfos and it took a long time of me beating down a lot of doors in order to get any funding and i just said let let me send them my way send them my way i'll take care of them interesting well thank you for that point uh susan seriously thank you so much for taking your time you are just more than wonderful um so if someone wants to contact you they just go to ada or um because um how would they follow up if they got a specific if they have a specific question they can always email me at Ebert s-e-b-e-r-t-s or they can just go to our website and email adapt adapt at uh what is that okay now i just had a blank go ahead and just email us at adapt um so you were trying to think of what the a website or uh no just if they have questions they can go to the website ada and there's a contact us form oh okay contact us let me see contact us at adapt okay let me see if i can find it okay create for free um sounds too good to save that okay um contact us yeah if you just go there um go to ada they got a contact sheet questions the email is adapt adapt and uh again thank you so much for coming on the show today it was just an honor to podcast you well thank you so much Howard it was an honor to be here it truly was all right good luck with those grandkids thank you you too
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