Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
How to perform dentistry faster, easier, higher in quality and lower in cost.
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Protocol: What To Do When with Steven L. Rasner, DMD MAGD : Howard Speaks Podcast #71

Protocol: What To Do When with Steven L. Rasner, DMD MAGD : Howard Speaks Podcast #71

5/7/2015 12:00:00 AM   |   Comments: 0   |   Views: 2081

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Dr. Rasner, a full-time clinician and industry veteran with over 30 years' experience, talks debt, success, and how to keep staff.






1055 N Pearl St, Bridgeton, NJ 08302

(856) 455-7785




Howard Farran: It is an honor and privilege for me here. I am at the Bellagio at the Townie meeting 2015 in Las Vegas with one of my idols and mentors for many, many years. I graduated in ‘87 you graduated in ‘80. I met you…I don’t know if you remember this? I met you…I signed up for Carl Misch’s seven three day weekend in Detroit way back in the day.


Steve Rasner: Absolutely.


Howard Farran: I don’t even know what year that was. Do you remember what year that was?


Steve Rasner: No I don’t.


Howard Farran: It had to be… I think it was like ‘88, ‘89, ‘90 at the latest and I just… one of those three day classes as I sat by you and man you mesmerized me with ideas and then of course you’re an amazing speaker. You’ve put a lecture on Dentaltown.


Steve Rasner: I did.


Howard Farran: It’s been one of the most viewed courses we’ve had on Dentaltown. So I want to get an hour with you.


Steve Rasner: Yup. 


Howard Farran: You’re a legend to me and many others. Next month 5000 kids are going to graduate from dental school and there are two dental schools in my backyard in Phoenix. There’s A.T. Still in Mason, there’s Midwestern in Glendale and seriously I know a lot of these kids. They’re scared. So you’re…I’m a grandpa, I’ve got a three year old granddaughter. What advice would you give these kids? How can they, 25 years later be successful like you?


Steve Rasner: Well I’ll tell you. I’ll tell you what I would tell somebody graduating now because I would do exactly what I did 34 years ago because you know I want to take you back to 34 years ago. You know when you use words about me like legend and all the unbelievably kind things you just said. I mean it blows my mind Howard because I really am to me just so ordinary. I’m just a guy who works really hard and have a great, great ability to overcome obstacles. You know of which I had so many in my face and one of them started in dental school when it was nobodies fault but my own and that’s, I just wasn’t that good. You know I was really in the bottom five of my class. It wasn’t by choice. You know I was definitely no Carl Misch who was number one in his class and all these guys that are just studs and because of that I didn’t have any opportunities to go to post grad programs. So I had to go back to the only opportunity I had which was practicing with my father. My dad was a mom and pap dentists. He wasn’t an educator, he wasn’t modern, he was a good dentist but you know nothing…


Howard Farran: Which city was he in?


Steve Rasner: We lived in a town in Southern New Jersey called Bridgeton. Now when I grew up in Bridgeton it was a vital town like many towns in America that went south because we had a glass factory that pretty much employed the whole town and while I was a away in college and dental school it went under, it closed. So the whole town went south and you know I honestly went back to my hometown very worried about what my future would be. I wasn’t really that excited to be honest with you know about practicing with my own father and there I was. So what did I did do? And now I know that I’m making this analogy to anybody out there right now. Because first of all I’ll say this. If you are skillful enough or talented enough that you can get a post grad program in a good place as a GP take it. I don’t think you ready coming right out of school and in fact I’m positive you’re not. And there’s nothing to replace talent to make you successful and the direction of this talk from me with you over this hour that we have is how you can remain an independent fee for service guy despite the fact you coming into a environment, or as Howard knows and I know it’s radically different than it was for me in 1980, why? Well for one thing you have corporate dentistry and you have offices and offices and offices out there, gigantic chains and groups so there nothing wrong with those guys, it just doesn’t serve you that well. You now you’re going to work for somebody and maybe in some of them you can make a decent living but you’re not going to have control and for me there is nothing greater than having the ability to call my shots and nobody can tell me what to do and the satisfaction of I have of growing my own business. I mean there’s a lot to be said for that. So I’m going to encourage you to take a road that’s going to allow you to be an independent solo owner unless you have the personality where you want to be in a group practice. And I’m positive that my blue print works today as it did 30 years ago. So number two let’s say you can’t get into a post grad program, I would work for a number of dentists right out of school. I would… if you can work for two or three, get two or three environments under your belt, learn how to manage different types of practices and patients. You’re going to have people that are very insurance driven. You know I think the one thing that you should not do, and you should really listen to me on this is don’t fall for the victim of getting yourself in unbelievable debt. Meaning you buy…don’t buy something that you can’t afford and I don’t just mean a practice. I mean don’t buy the big house and the big car; just give it a little time because the worst thing that you can find yourself doing is working to pay bills. You know you’re just going to be on a fast track for burnout if you do that and so let me go back and tell you what I did. So I’m in this town, you know everybody is moving out and by the way this has latest for my whole career. Business after business just collapses, all you see is for sale signs. To give you an idea we are about an hour east of Atlantic City and an hour south of Philadelphia. So picture this is very southern rural houses spread all over the place. There’s nothing urban, we don’t even have a Starbucks we don’t even have a Dunkin Doughnut, so that’s…no movie theatre, probably a couple of diners. That’s the environment that I practiced in so the first I thing I would tell you is educate yourself because I don’t know if you have done this recently Howard? But if you go out and ask Limoli or Charles Blair, guys that are real authorities on the insurance environment today, I mean what do you do when we’re getting paid 60% of what we used to get paid? One of the answers is you work harder and you just produce more, you know you work 50% harder, 25% harder, see more patients per hour. I mean that’s not what you guys signed up for, I’m quite sure of it and so I want to give you my practice today and I will tell you how to get there in a second. My practice is…I walk in literally and I would not insult your intelligence by exaggerating. This, what I’m telling you is real. I see four or five patients for real per day and that’s about three and half to four days a week. Most of the patients are sedated and on Townie I did a course on sedation and lots of you…I will repeat some of it here. Lots of you reached out for me to know what that was about. See the thing is this, the only way to beat the insurance companies is to have a skill and a talent that people will go out of network for. I want you to think about that. The worst thing that you could say in your office is we don’t take insurance. You do take insurance. You take their insurance, they’re just going to get paid less by coming to you. So will some people do that? Absolutely. Everybody that comes to me goes out of network. They’re going to get paid, they’re just going to paid less so what is it I do that makes it worth it? So what is it you could do? Well think about the skillsets that you can add right now. You think that becoming just an amazing restorative guy is going to get people flocking to your door, no. How about endo, ortho? Absolutely not, you could be the best guy in your state in these things and people are not going to shout to their neighbors that you’re a great endodontists I am mean as a GP. Oh by the way the most remarkable thing about you coming out in 2015 or ’16 is as follows, I want you to think about something. If we were physicians…you guys, physicians…if you’re an internist and you’re having a bad year or couple of years, you can’t take an online course or a continuum in cardiology. That’s not how it works, but we’re in a profession that is so amazing because you can do it. I mean think about this for a minute. One of the best implantologist in the world, the most renowned one for sure, Carl Misch, is not an oral surgeon and he’s not a periodontist, he is a prosthodontist and some of the best implant guys in this country are GP’s and some of the best guys that do endo or ortho are GP’s because for some reason our profession is set up and allows us to take advantage of the education and develop these amazing skills sets but the skills sets I’m going to tell you to go after as follows because they’re a perfect merge for one another, a perfect match and one is the skill set of developing an oral sedation practice. So let’s say it’s…you’ve got two years under your belt and you have the opportunity to purchase a practice. First of all be sure…I’m no expert I’m not going to try to be on purchasing practices but you certainly want to purchase a guy’s practice that…you’re better off purchasing a mom and pop practice than a practice like mine. Mine would not be a good practice to buy, why? Because I’ve restored everybody, you wouldn’t have a lot to do. You want the guy that’s been doing five service amalgams, that’s the practice you want where 75% of the patients have some type of soft tissue disease. I’m not kidding that’s what you want and you should really wait for that opportunity before you go out and purchase the fancy dancy practice. I would not do that and by the way when you purchase that practice, I know we are off on a lot of tangents right here, is this okay?


Howard Farran: Absolutely, you’re doing great. Can I just add one thing to what you said? 


Steve Rasner: Yeah


Howard Farran: I know…every year I know one guy that buys a 70 year old guy’s practice that all he did was MOD amalgams for his whole life


Steve Rasner: Okay.


Howard Farran: And the next 10 years they own that thing every single day two, three or four of his MOD’s break and they come in a do a thousand dollar crown. So they just sit there and do four $1000 crowns a day, four days a week for a decade because they bought that mom and pop practice of some guy that all he did was the big old huge amalgams.


Steve Rasner: Yeah so you’re collating what I’m saying. 


Howard Farran: Oh absolutely.


Steve Rasner: It is exactly what you want you want to do. Let me give you another cavy out here that’s really important. When you are in that practice the first year and I mean like at least the first year, you’ve got to suck it up. I’m telling you don’t try to restore the world in the next 24 months. What I would do is you got to buy their trust because you’ve got to remember something, they have been going to a guy that they trust more than you and they should. It could be good old Joe, he could be an average dentist, and he could stink. The fact is, if you think about it for a minute they haven’t had to spend a lot of money and you’re coming in and you’re asking, even if you’re doing the right thing and I’m sure many of my fellow dentists out there will echo this. I can’t tell you how many patients I’ve lost by telling them to do the right thing. I can think of a guy right this minute that came to me for…this is a true story…came to me for 20 years flawlessly. I mean him, his two children and his wife, they never missed an appointment he also never spent a dime. I consider that a great a patient and he had a head light crown on number 8, meaning he came into the room a few minutes before he got there and it broke to the gingival margin, it was endo tooth, this was before me, he had this kind of even before me and it was a clear case of an implant. I never saw the patient again, did a treatment plan, did it just like I would for anybody else. You know some people are going to leave you always because of money and can’t let that dictate your philosophy of care, but going back to buying a practice. What I would do is I would introduce myself, I’d ask them how their mouth feels. If they tell you it feels fine that there’s no problems, unless it’s glaring, you have to soft tap this first and maybe in second recall until they trust you. You will never ever stop thanking me for that because if you’re going in like Rambo and I understand that, you’re staring at a MODBLGFT amalgam and bam it’s just begging for a core and a crown or they’ve got early soft tissue disease, look if they’ve got radical pathology, if the have periapical disease and by the way a lot of these patients have never had x-rays and a full set of x-rays in the last ten years, that is one thing I would do. You know if you lose them after asking for appropriate diagnosis and you lose them, you know for diagnostic material but that would be my approach and then once you get their trust you slowly build and you probably would start that with their soft tissue health because it’s an easy thing to explain and it’s also something that has effects on their other systemic organs and stuff so it’s a real good way to approach it. While I’m on this I want to tell you about something else because it’s all just merging to me right now. I want to talk about how you should examine patients real briefly. I’m talking about the new guy out there and even some of the old guys because people you know are amazed at the extraordinary productivity, that’s why I got asked to speak over the years because I had this office in that little town we are talking about that did a million before I could blink an eye and I remember my father was doing like a hundred grand and I can’t remember Howard, it might have been four years because remember it’s 1984 you know and out of a 2000 square foot building in the late 2009/2010 we started exceeding four million on a four day work week. In that same town by the way. The town ranked by USA Today as the second worst place to live in the United States, look it up, Google it. You’ll see it. It’s true. In that town that’s what I do and you know I assure you all the dentists in my town probably think I’m nuts because I’m unabashed about charging services that I think I earn, you know I don’t mind giving you details. Everybody knows I’m about the truth and I keep it real. So you know I’ve been getting 1450 plus a core you know 50% of the time which is 350 so let’s say 17, 1800 dollars for most of my crowns for the last eight years. I haven’t raised my fee on a crown in eight years because I was so ahead of the curve to begin with. I would say to you unequivocally that the next closest fee in my county, not my town, my county has three cities that are about 75 000 people, would be about 950 because everybody is scared to charge a fee because everybody is going to run and I’ve been doing that for many, many years and if you ask what my reputation would be, I would say my reputation is that I’m a really high fee guy, I’m really expensive is what people would say but he’s really good and I’ll take that reputation and I would…I’ve said over the years that I’ve been teaching and speaking- the really rare combination to find that works, it’s so ridiculously obvious that I feel funny saying it. You will find a lot of guys that are great clinicians that have no personality. You’ll find guys that are great clinicians that have a horrific staff, a staff that doesn’t want to be there, a staff- there’s bickering amongst the staff. A guy that has an outdated facility or that it’s not clean. It’s rare…or you’ll find somebody that has Taj Mahal and no clinical skills. It’s really hard to find a combination of great clinical skills, real passionate people person and having a terrific team on top of it and I will tell you Howard. It’s unequivocally what I have. I mean I have had bad hygienists, I know the difference. I’ve had bad front desk people. You know I’ve had people that it’s all about me and every time I want to ask a staff member to do something extra, you know how much am I going to get paid extra? You know you’ve got to…it’s a journey, you can’t expect it develop over night and but I will tell you the blueprint that I’m going to share with you is a blueprint that absolutely works, I mean and it doesn’t cost anything, it’s ridiculously obvious to me and it’s this. So you educate yourself first and your team by the way. So that’s going to feel funny to you because it’s going to feel funny spending money right out of the gate as a young dentist but think of it as well you’re not doing a post grad program. So if you were you wouldn’t be earning much money anyway so I’m telling you right out of the gate I would start training myself and for my dollar what I would train myself on is oral surgical skills and I don’t mean third molars, I will come back to that. The other one would be obviously implants. I mean I didn’t start that with you, I was in my mid 40’s I believe or late 40’s and I actually am hired by implant companies to teach implants and I was the guy in the bottom fifth of my class by the way so if I have that skill level at this point just imagine what you could have if you’re in your mid or late 20’s and you start doing it. You know and I know you can attest to this and all the great speakers on your forum can too. Implant dentistry just makes you a better dentist overall because you have to understand so much other stuff to do that. You have to learn about angiogenesis, about bone growth and growing and grafting bone because you just can’t do a lot of implants without having to run into that and things that you never thought, you wouldn’t even imagine that you would do as a second or third or fourth year dental student. Five years out you’ll be doing. I mean imagine doing a sinus lift for example, you know lifting the sinus to grow bone which sounds like you know open heart surgery to you right now but I’m here to tell you it’s an unbelievably by the way easy procedure in a round of a procedures that you will learn. So that’s… I know I’m all over the map here because I’m so excited about wanting to share with you stuff. So you’re investing in yourself first, that’s a given. When I say that to you let me tell you what I used to do because I remember it vividly. I swear to you I used to treatment plan my year educationally. I remember doing it, I don’t do it anymore, but I in January would break down the quarters just like you’re in college, I swear to God that’s what I did. So I would take like a continuum every year. I went by the way…I went to Frank Spear and John Koi’s office 22 times over a period of ten years.


Howard Farran: When they were together?


Steven Rasner: When they were together and when they were apart. I went to them when they were together, you’re right, they used to give two day courses and by the way you know it’s really important that you ask around about who should you learn from because there’s a lot of people to learn from and there’s only so much time you can spend. So what do you want? Of course you want somebody that has the most bank for your buck and somebody that lots of other people swear by. I’m saying that to you because obviously the Spear Institute is probably you know one of the world leading places today for basic restorative dentistry but there are others too that are excellent and you can’t take them all, but I would every quarter treatment plan what I was taking and I did and paid that… by the way if you pay the courses ahead of time which I know you right out of school you don’t…it’s a little challenging for you. You won’t not take the course, so I would put a deposit on it and I would take a continuum. I think he had like 12 continuums when I did them, I’m talking about Spear. So I would like take two of those a year which is two and half days. I know I went to Seattle 22 times for one thing and then implant dentistry is the same thing. You know you’re going to start with a mentor you know whether it would be Carl Misch or the boys down in Atlanta, the Salama brothers. They’re some really good places to start and you know I think you should be taking three or four courses a year you know and if you certainly can do something for the whole team like you know a Dentaltown meeting or something like that you’ll become an extraordinary clinician and owner of an office because very, very few of your colleagues do that. And let me explain something online courses are wonderful but when you are here in person…I know it might have cost you $5000 I know that is a big thing to bite. You just learn so much like in the lunch breaks or walking through the exhibit hall. Just even clinical little tips you know that you’re getting. So I would really encourage you to make the educational part of your year an absolute commitment. You know to yourself and at least one for your team and that’s what I did by the way and I don’t think it’s an accident that my team is still with me and I have a team of twenty people now and they have been for an average of 18 years so you know. I surely pay them well but I can promise you money is not going to be the only thing that’s going to keep them. Let me tell you what would keep people with you. You, your attitude, people don’t want to work with a guy that’s a SOB you know and if you’re a SOB 51 weeks a year and you take your staff out on the week of Christmas with a limousine and you give them a $100 gift card, just send it to me next year because you are wasting your money. You know that just doesn’t work, you know you got to be the guy they don’t feel terrible about on Sunday night knowing that they are going to see Monday through Thursday and think about it, it just makes sense. You know some of you are born leaders others of you can learn to be leaders but you know nobody wants somebody that’s a SOB and if you practice under the realm that I’m going to try to get you to there would be no reason for you to be a SOB, because you’re going to be loving life. So you educated yourself, that’s exactly what I did in the early 80’s. One of the skills you want to get down is oral sedation and I will explain to you why. First of all there is no skill set, you hand people pills and they take them, where’s the skill? The only skill is keeping it safe. Now if you go back to Dentaltown and look at my course, or if you reach out and contact me or both, I’m pretty sure it’s in my course Howard. I give a combination of Benydril, Atarax and Triazolam. I don’t know anybody else doing that I didn’t invent it, an old surgeon gave me that idea from down in Alabama, and it’s a cool story by the way. This guy came to my office, taught me all surgical skills over the last ten years. I never went to his office but I coached him at dinner and I would coach him over the phone and we took his practice from 700 to 2.7 million and the guy, when I met him was 68 by the way and was burnt out and he was losing his number one assistant and I remember getting on the phone. If he’s watching this you know who you are. I got on the phone and talked to his assistant of 17 years or whatever it was out of quitting and she stayed with him another 17 years. She just left just now, but during that time we took his practice as what I’ve just told you. So the first thing is oral sedation. Let me tell you why because your skill set as an implantologist will not be year five what it is day one, you will be better but your skill set as an oral sedation dentist will be as good as mine the first time you do it because as I indicated there is no skill you know except keeping it safe which I will talk about briefly. So we give them the pills, we don’t not charge them, I would pay them to take it actually if it came down to that. That’s because it’s so freaking awesome. They take the tree pills 90 minutes before they get to your office. When they come in they’re either going be zonked, that will be about 10%. You will need a wheelchair so you have to invest $250 in a wheelchair. Wheel him back to you operatory, that operatory is dark. You hook him up to nitrous if you don’t have nitrous and you don’t want to invest in plumbing you whole office you can get a portable one, a really good one for about $5500, top of the line, porter or whatever it’s called. You have to have the nitrous if you really want it to work. If they are zonked meaning literally sleeping, I said that will be about 10% you put them on 100% oxygen just to keep them safe and you’ve got them hooked up to a pulsoxsimeter. Hey while I am thinking of it I’ve done this protocol for 17 years, I have never as in never not one time had an incident where I had to pick up the phone, call 911. They’re breathing slows down to a scary level or they’re passed out, nothing, they just sleep, and I’ve done it from 88 years old to 18. Safety level, I told you I’ll talk to you about safety. Just don’t do it with kids, bottom line. If they’re under 16 years old let them go to a specialist, let them go to the hospital. Do you even want to put that under your belt? Just forget about it. Other than that you are going to get a clearance from the physician, you have to delegate in my world so I’m not picking up the phone and getting on the phone with ten physicians a week. I have somebody do that for me and I’ve never been denied. So why am I telling you about this? Why is this worthy of this conversation with Howard? Because that is the thing people will talk about. People that are scared are so…in dentistry, are so emotionally driven that it’s beyond belief. You may not know what that feels like right now because you don’t have an oral sedation perhaps. I’m telling you they will come in, they will come into your practice and it’s very similar to somebody that’s…like an infertility specialist. I like to use that analogy on purpose because…


Howard Farran: Is that because I’m talking to you, you know I’m shooting blanks?


Steve Rasner: Because I’ve lived that life. I lived it with my ex-wife and when you are with a woman that’s 38 years old and doesn’t have any kids yet and she is really panicking and she hears about a great doctor in Ohio and trust me I did all that. We went to Florida, we went to the Mayo Clinic in Ohio or Minnesota. We went everywhere. You will pay anything if you sense the confidence in the clinician talking to you. Well let’s flip that into dentistry right now. Here’s what you don’t know, these people that are scared, this isn’t like a little game or a funny thing. These people have a handicap, I’m telling you something. There’re going to come into your office, haven’t been to a dentist in 10, 20 years and it’s all races, it’s all socio economic boundaries, it does not matter.


Howard Farran: Even men and women?


Steve Rasner: It’s same, it’s men and women. You’ve got the most bad ass guy in the world, third black belt in karate and he’s terrified and it’s because it’s such a vulnerable part of your body. Think about it, in the mouth is a very vulnerable spot. I’ve never been hurt but you know somebody gives me a block and I’m scared you know when I’m in a chair. So when they sense the confidence in you and by the way you’re going to get your confidence in the first case, why? Because it works, remember this. I mean try it on your, maybe you will laugh when I say this but you are going to have to get a license to do this by the way, so let me divert to that for a minute. It’s all over the place in the country. If you’re in New Jersey it’s awesome, it’s 60 credit hours once and then 20 every two years. I mean if they made me walk across the United States I will do it to keep the license. In the state of New York you have to do an IV course even though you’re just going to give pills so it’s an IV sedation course, I’m telling you do it if that’s what it is and I wouldn’t even do IV which we used to do in my office, why? Because number one you do have to charge for it, two the possibility of something going wrong is just too high for the positive outcome of it. I just wouldn’t do it, that’s some reason by the way, when you heard me earlier taking teeth out but not third molars. I mean do a third molar, think about it for a minute. There is nothing scary between 18 and 31 I mean you are going to have to work hard to mess up the patient. You know the course of paraesthesia but the odds go up significantly when you go one tooth further, that or bleeding problems you know, so I’m telling you…and for what? For $500 a tooth? It’s just absolutely in my book not worth it. I know it makes you feel like a big shot and accomplished because you can take third molars out but the risk to reward is just not…it’s just too high for me. So I’m telling you not to do that. Just like I don’t think you should sedate children under sixteen years old. Same thing, I don’t want anything in my life or your life that could happen, that could set you off and spiral you down into a space that you don’t want to occupy for the next five years, like law suites or bad press or anything like that and there’s so much abundance of other stuff do without it, why even dream of doing it? Okay, back to my thing. So you’re…these people are going to tell everybody about what happened to them. They are. They’re going to tell, you won’t believe what happened to me at Dr. Farran’s office today. I’m telling you they will come in by the droves and I hate when people tell me how to get patients in my office and they say the word droves, there is no other skill that you can pick up and remember as I said there is no skills set to this. It’s just getting a certificate that allows you to administer the pills which we hand out in packets, we have directions on them. We give it to them at the consultation if there is a signed treatment plan. They sign a consent that I will fax you if you want it that says they can’t drive before or after the visit. It lasts about four hours. I didn’t finish telling you about the other percentages. So people come in zonked. 80% are going to come in…10% will come in wasted, 80% are going to come in perfect for you. They’re giddy, they’re funny they like it and I mean if they’re 80, oh I didn’t know this, I haven’t felt this is years. You put them in a chair, it’s dark, you put them on gas, go on YouTube you’ll see I have at least five videos. They literally snore, almost everybody snores. You need bite blocks to keep them open by the way, lights are out, and you’ve got the highlights in your head. You put cool music on, it’s like you’re in an operating room. I’m not kidding. It is such a cool vibe and environment to spend your days as a dentist. Now if you’re going to do what I’ve just said naturally lots of the people are going to have teeth extracted. You know that’s why, if you’re going to do an oral sedation practice it doesn’t make a lot of sense unless you’re going to learn oral surgical skills like removing teeth and implant dentistry and then it just becomes an incredible merge of coolness in what you do each day. You guys are not thinking about this right now because you know doing a complete round house which I’ve never done by the way. I don’t think I’ve ever done a round house. I’ve done first bite to first bite, maybe first molar to the first molar. By the way that gets really unappealing as time will go on for you, you’ll see but I will tell what never gets old. It never gets old because every implant case to me is different. You just never know, you know do I need to grow bone, do I not have to grow bone? All the prosthetic things you’ve got to like learn and all the cool tricks and it’s a life changer. I mean the cool thing about you guys coming out right now is that when Howard and I came out there was no alternative for most of us for edentulous patients on lowers. If somebody with an atrophic mandible was in big trouble. I took every denture course that’s out there, I took them three times. I can tell you I was the guy that brought the patient…I remember I’m the one who brought the patient on a lower denture I’m talking about, how to make the most amazing lower denture and it was my patient from my town who flew with us and we were all sitting around the chair and we are looking at her and you know, wow isn’t that amazing. Wow it has great retention and guess what? I know for a fact it didn’t because I got to see her again because she’s from my town but you guys live in a world to make those prosthetic options for patients obsolete. I mean I can say Howard I had a patient this week and I’m pretty pricey on everything I do. I think if you train for excellence, you absolutely should get paid for excellence and when I say that, I can say with full confidence that at this point in my career and maybe for many, many years we’ve got it all going on. It’s not just that I got a good skill set. It’s I’ve got people at the front desk that get it. That understand, that remember and they connect to patients and understand the importance of returning phone calls in one hour with a solution to people, because that is the number one reason you’re going to lose patients guys because you don’t get a call back. That is the number one reason you lose patients and it’s the number one reason you get new patients because they couldn’t get into their dentist. So you have to have protocols for things that matter and while I’m talking about protocols let me tell you two other things that matter. One of the reasons I have such extraordinary case acceptance… you’ve got to remember what I’m telling you this, it’s in that town right? I’m not in Philadelphia or Cherry Hill in New Jersey which is a nice suburb of Philadelphia. I’m in southern New Jersey where probably the biggest employers are migrant farm workers or… you know fishermen, retired farmers, a lot of prison guards, I’m not kidding. That’s who comes to me I mean at this point in my career I’ve been around a long time so I have, I guess whenever somebody does come to me you know I’ve got professionals as well but the bulk of people that come to me clearly are blue collar, no doubt about that and so these people come in so one of the protocols that we have is having a significant other on the first visit. So remember I just said, I’m set up to get case acceptance, how can you guys possibly get case acceptance? Right now I’m not even talking to the young dentists. I am talking to everybody. In today’s environment if you doing comprehensive examination, so let me break that down. Do I have time do this?


Howard Farran: Absolutely.


Steve Rasner: Let me break down what comprehensive exam means to me and you know I’m talking… everybody who has been to Pankey or Dawson it doesn’t matter. To me all it means this and you can even use this by the way, when somebody comes into see me… so I want you to picture this. They are sitting in my operatory, they have been screened over the telephone by the way so I am going to divert to that and then come back to operatory. Screen means this, when they call my office, Michelle is going to tell them, that’s my new patient coordinator. She says something at some point, she asks them five questions about their mouth, this on a very first call. So the caller gives the name and she inputs the insurance information and now she says… well we call it a mini dental history. Let me ask you a few questions about your mouth. When was the last time you went to the dentist? You know do you have anything that comes in an out, removable? How would you say your health of your gums are? Whatever your four or five question you want them to be, nobody is going to stop you on that by the way. You need as much information as you can to…I don’t know what is the word? To screen this patient and she will say this. This is how the first visit is going to work. Dr. Rasner is going to take a look at your whole mouth. You know don’t scare them away don’t say I’m going to do a Pankey exam, of course you’re not going to say that. He’s going to take a look at all your teeth and now remember they didn’t call and asked me to look at all their teeth. They called because they wanted a tooth pulled or they had pain on the lower eighth, but we are telling them we’re going to look at their whole mouth and we are going to take what ever x-rays we feel are necessary to give you an accurate diagnosis. When you do that one of two things is going to happen. Number one somebody is going to say to you oh I don’t want all of that; I just want my tooth removed. Well then you will explain. Listen I’ve been with Dr. Farran for many, many years and one thing I’m positive about is you will save time and money if we have all the information that we need and pretty much everybody wants that, if after you say that they don’t want to come in they don’t want to come in because anybody out there can detest that we have two hands in this profession all the time. That’s all you’ve got and so you can’t afford to do what’s happened to me over my career which is why I have that protocol. To look at a patient like I just told you and have my hygienist walk into my room and say he won’t let me take x-rays because I already screened them. They know I was going to, or he doesn’t want anything, he just wants his one tooth pulled. That never ever happens to me because they have been screened over the phone. Okay so that’s what screen is. By the way when they get to the office there’s a re-screen for two minutes in a private room by Michelle again, because people often lie over the telephone. So a lot of times they will tell you I have no other problems and they will have perio buzzer breath because she is going to coach me before I meet them. I mean think about what I’m saying. Is that really so foreign? I want to know as much as I can when I walk in this room because this is my opportunity. This is my moment, this is my chance to… and whether you like it or not guys we are selling right? I mean they don’t have to have a third molar because we don’t have to have number three, you can live without it. You don’t have to have back molars to live, you don’t need to have teeth to live. It’s better to have them but patients know that. You don’t have to have an implant on number three. So whether you like it not, no matter how good of a clinician you want to put it, we are in an elective business to a degree. Yes they have to have the tooth pulled but they don’t need to have it replaced. So I have an opening of five minutes maybe or less to explain the value and have them want that value of what I’m about to offer which is comprehensive care. So they are sitting there and I walk in there and I say this, you know what? And I am sitting there by the way, I’m not standing, I’m eye to eye just like many other legends used to tell you to do and I say look. I want to tell you a little bit about my practice before I start. I ask them how they found me right off the bat because that always solidifies relationships. You know if it’s word of mouth it’s going to put you instantly in a psychological more powerful position and I think that’s important, and I’m looking them dead in the eye and if you know…. And by the way for me and that’s going to happen to you, I don’t know why they do this but they literally come in with four or five of my ads which I haven’t talked about yet because all my marketing is geared towards the fearful patient. It’s not all over the map like it was for years and years. You know when you market you have to brand the one thing that you want to be known for. Okay that is what it’s all about, and think about it like what could you say, what are your real options that are going to draw people in? And we know that’s for another lecture or maybe a course I can give on your…my view of marketing Howard but you know what mediums do we use you know and I will just tell you right off the bat, what works in one city doesn’t always work in the next. I happen to know that from personal history but I do know this, whatever medium you’re using to talk about the service and your product, meaning your skill and your office, you have to identify the one thing that you want to be known for. Not a million things and if you think about it, what could be better than sleep dentistry or pain free dentistry? And I don’t mean making it out about kidding the cowards. I mean something way more sophisticated than that. And that’s what… people will come in with three, four of my ads tucked under their arm and say I’ve know about you for years, I finally got up the guts to come to you and I say well let me tell you a little more about my office. I believe the most important skill I could have is something I call what to do when? I’m telling the patient this and I’m telling their spouse that’s sitting in the chair next to me the same thing. So they’re sitting in the dental assistant’s chair and my patient in the dental chair and I am looking at them just like I’m looking at you right now and I’d say so I want to tell you what I believe in, a lot of philosophies I’ve developed over the years but one of them is called what to do when? I’m saying it just like this to the patient and let me explain to you what that means. It means no matter what you’re telling me the reason…I’m telling the patient this. Not matter what reason you came to me you don’t like your smile, you broke a tooth, you have pain on the lower right. I’m going to look at five things before I’m allowed to tell you what to do and then I’m going to ask you one. Here’s what they are… I’m telling the patient this. First thing I’m going to look at the health of your gums, do you know why? Because one out of five people in this country have no teeth in their upper or lower jaw over the age of 60 because of gum diseases. That’s how prevalent gum disease is. So if I can stop you from that, how can that not be number on my list? I hope you’re with me, it’s exactly how I’m talking to my patient. Number two I want to look at all of your teeth, every one of them. Why am I going to do that? Because teeth are like any other part of your body, they don’t have to hurt when something is wrong and I now noticed you already have two root canals in your mouth. Those root canals didn’t start the day you came to the dentist. They started months before so wouldn’t it be better if I could fill your tooth instead of root canalling it and capping it? I mean it would be better than at least a thousand dollars. You hear me? That’s how I am talking to my patient. Then I say I’m going to look and see if you have any missing teeth and is that even an issue? Mind you I’ve been coached by this by my Michelle, new patient coordinator already so I might know that missing teeth is already an issue to them but I’ll still say that. Four I will look at you bite to see if that’s got anything to do…let’s say they came into me because they have a crown that kept popping off from their last dentist, as soon as they say that I’m either thinking insufficient tooth structure or you have a bruxism problem okay and they usually know if they have bruxism problem. So they think and connect to you as you…you know what I’m doing by the way? I’m explaining to them that I’m doing a full comprehensive exam without saying it and the value of it so it’s never like weird to them and why would I make a big deal of this is? Why is this even something that I have to explain? Because almost none of you colleagues do it, those of you who are on Dentaltown you think you’re the norm? No you’re not the norm. The norm doesn’t take courses, the norm fulfills the requirements because they have to keep their license. The norm is burnt out, the norm is in debt and working to pay their bills. You’re not the norm and ride it out the maximum of your potential because you have so much more than a guy that’s burnt out. I mean I hope I can reach that guys as well so back to what I was saying. That’s why you’re doing it because most…what’s happening to these patients in their dental careers is that they are walking into the office and they are walking into a burnt out front desk where they walk into the room you know the receptionist like points sit down, you know I will be with you in a minute, just like you’re treated by the way at some physician offices, same way and that feels real value right? You know in my place by the way and it means Jack squat if your work doesn’t work. They’re walking into my reception room which isn’t beautiful but it’s got a refrigerator full of not just water, apple juice, grape juice, orange juice and every single day there’s either fresh fruit with toothpicks in it or cut up cake that we got from somebody made. I mean like banana bread or something and it’s clean and they’re looking at somebody that’s a got a smile on their face that is waiting for them. Again it means Jack crap if your work stinks, but if you work’s you know kicking it, how can you beat that combination? You know and they are not walking into packed waiting room either, you know and I got a computer in there if they want to go online and just all this kind of stuff. So back in my operatory…so remember I told them I’m looking at their gums, their teeth, their missing teeth, their bite, finally I’ll say and I’m going to look at your smile, if that is important to you then it will be important to me. Understand how I said that. They are very suspicious about a lot of us and you know that so there… you know I don’t want them to think that I’m going to want to veneer the whole mouth or you know get in their pocket book. I’m coming off as I’m saving you money by taking a very thorough approach and you are by the way, how many times have you guys seen, or you will see a root canal and a crown on number 31, there’s no number 30 or 29 there and it’s almost at a 45 degree angle for what? Why did you do that? You know because you wouldn’t have done that if you had examined her whole mouth. Sometimes the best thing to do is get rid of the tooth and maybe put an implant in the position of 29 and 30 instead of trying to save 31. So that’s why you’re taking them through this and then I said there’s one thing else I say. Here’s the last thing I say, I say and then the last thing that I’m going to ask you is what do you want? I mean what do you want? You came in here today, you’re nervous, you told me. You know you have multiple missing teeth, tell me what you would like if you could have it and so that’s my… I call it sharing my philosophy of care and I’ve got to tell you, I mean this. I have never said that and not connected with somebody, never, not once. Never has somebody looked at me and say why are you talking about all this? I just want a tooth fixed, never and you’ve got to remember I’m talking to people… they really aren’t sophisticated. I mean I don’t want to be mean about it but they’re not and Howard I’ve had people with…if you just judge them by their clothes I mean torn sneakers and certainly no sense of style of whatsoever on them. I mean they look poor to be honest with you and go for treatment plans I would have never ever dreamed. Look I don’t care by the way, I also tell a patient this. I like this so, I have a book and I’m not here selling my books but it’s called The Blueprint for the Extraordinary Practice and in it I have a chapter what I call raps, you know like singer raps? Well my raps are like… I’ve got a rap for the new patient that I’ve just shared with you a minute ago, to do the comprehensive exam and I have a rap called less is best by the way but the rap…God I forget what I was going to say.


Howard Farran: About your book. When did that book come out?


Steve Rasner: About a year ago. I’ve got to get it on your…well if you have something I can advertise it, it’s a compilation of everything I know by the way. I wrote a book, The Protocol Book on what to do when. 


Howard Farran: I shouldn’t ask you this live on tape but I’m going to throw it at you anyway. You know Jeff Bezos of Amazon says that now audiobooks are outselling books. He’s now 51% audio books, 49% book because when we were little to read a book we had to sit in a chair for six hours and read this book. Now these kids are on audiobook and they put on the audio book while they do their laundry and their dishes and work out. 


Steve Rasner: That’s what I would do. 


Howard Farran: So the Dentaltown app passed 25 000 downloads its first month and on the app we, the reason the podcast passed 50 000 downloads so far is because they’re on the app. So the reason podcasts are so successful is even though you can see us now if you are in the website or YouTube, 90% are going to be listening to this up on their cell phone while they’re on treadmill or whatever.


Steve Rasner: Yeah.


Howard Farran: And we’re launching next month our first audiobooks and I can’t think of anything more cool than to debut our audiobooks with your books.


Steve Rasner: Oh I will do it.


Howard Farran: And I would love it if you would get in a sound booth. I mean you can send us the books and we can hire a professional reader to read it, but you’re such a dynamic speaker I think you should read your own book.


Steve Rasner: That’s cool, yeah, I will do it 


Howard Farran: And that’s no money, no cost.


Steve Rasner: How candid is this it’s pretty cool.


Howard Farran: It’s all free by I guarantee you this doc, if you put your audiobook on there, dentists from every single country on earth will listen to it the first day.


Steve Rasner: Well I guess I have some cool stuff to share and I’m not kidding you. Look this started out with Howard asking me what will I tell the 5000 students graduating next year and we got into this whole history of how to be successful in dentistry and I’m glad that it went into the direction, but everything you’re hearing from me, I want you to remember something and not to discredit guys who don’t have this. I’m a full time clinician man. I mean I’m full time. I’m working Monday and everything you hear me say to you is from my day to day experiences. My protocol book called What to do When, is what that really was, I got tired after 20 years of not knowing what to do when. My hygienist looked at me all right, my patient is 20 minutes late and I will say well you guys can relate. You know my out of town patients, right… do you love it when an out of town patient comes to you? They moved away and now I’ve got people who come to me three hours, do you not think I want to know when their crown is loose, coming in for the hygiene visit before they get there. The worst thing you can do is, oh you mind coming back and then got to squeeze it in your day and you know you’re going through all that kind of stuff. So the protocols came from that, everything, like how do you start your day. I got tired back in the day of one of my processes, you don’t need to do that any more. I do that but my computer is up and running. I want to make sure all my equipment is working. You know I call that the ready to work protocol. So I do, everything in that book was stuff I wrote it down for me, not to sell it and after about a year and a half, two years I had hundreds of these protocols like what do you do when somebody calls and it’s a loose crown? You’ve got to ask certain questions over the phone. You know I have somebody who wants an open appointment in the day, did they get it? In my protocol only if they never broke an appointment, why? Because you can’t fix the opening eight o’clock appointment break and you only have eight hours a day and hygiene by the way is the most predictably profitable centre in your office. Meaning if somebody is in hygiene and you fill that schedule with eight patients that day whatever it is, you are positively going to be profitable. Why? Because there’s no redoes, there’s no I don’t like the shade, there’s no the frame work didn’t fit, back to my last step about art of the close case presentation. I remember what I was going to say. One of my raps is this. I say to the patient, I think you should mimic it, at some point I slide in there this talk. You know I really think it’s my job to give you the most conservative treatment plan that will work. I actually say that to that patient. I’m actually telling them that I’m going to try to be as…now they know what conservative means you know, meaning is least invasive and is least costly as I can possibly make it, if it will work. Now that doesn’t mean doing a seven surface core build up on a tooth that really needs a crown you know and that doesn’t mean doing a five unit bridge with three ponics. That actually excludes those things because the operative word is what will work. Anyway I could go on and on with this but I’ll throw it back to you. 


Howard Farran: I think what you are saying is amazing. I want to pin you down, I only have you five more minutes so you mentioned that…so these kids are probably wondering okay you said to learn restorative, you said there was Spear and there’s Kois and now those guys are…when we took up they where together.


Steve Rasner: Yeah.


Howard Farran: And I can remember taking them together. Is there anybody else? Like on the West Coast there’s Bill Strupp, do you recommend Bill Strupp? 


Steve Rasner: You mean on the East Coast?


Howard Farran: Yeah on the East Coast.


Steve Rasner: Oh Bill Strupp is hands down a guy you should see. I mean hands down. First of all he’s loveable, I’m telling you guys…remember me telling you this, you now why? I will tell you why he’s loveable, he makes you feel valued, he makes you feel that you can be…I hope I do that by the way, I try to emulate that. He makes you feel that you can do exactly what he does. Like it’s not exclusive to Bill Strupp’s hands you know?


Howard Farran: And what I…the high self esteem guys that I love the most is that anybody can go up there who’s 50 or 60 years old and cherry pick there ten best cases and make you feel like you’re an idiot and they are God and Strupp has such high self esteem. I remember him making me laugh so hard I was crying because when we got out of school you know the cosmetic revolution was brand new and they told us that these new all glass dyecor crowns and we can cement them with duron. 


Steve Rasner: Yeah.


Howard Farran: I paid money to learn that a year in MPC, so Bill and I we did these. Guess what percent of them broke and had to be replaced for free?


Steve Rasner: What is it?


Howard Farran: 100%. 100 % of them and Bill is so great because…he is in Clearwater, Florida which is just North of Sarasota and I love the guys who go out there and say and you know you shouldn’t do this because let me show this nightmare that I did with my hands.


Steve Rasner: Yeah exactly.


Howard Farran: And when they can show you their failure and then they can relate to you that you’re human because we’ve all had failures. I remember just five years ago I was looking at a PA of a root canal and I told Jenn in 28 years I said that has got to be the worst root canal I’ve ever seen. What the hell do you think that…what do you think they were trying to do?


Steve Rasner: Yeah.


Howard Farran: And she said Howard you did that in 1987. I was like oh my God.


Steve Rasner: Oh my Gods that’s fabulous.


Howard Farran: You know I’m like 52, I’m like at 24 I did that and that is one reason you why should get more training after school. So that was restorative. You talked a lot about implants. What implant training would you recommend?


Steve Rasner: Okay well here is…I know you guys can tell that this interview is about as candid and as real as it gets. So what I’m about to say goes with that, by the way Strupp did my teeth and I paid him for it, my back eight teeth. That’s how much I think of Bill Strupp.


Howard Farran: So they’re all gold then?


Steve Rasner: I’ve got gold on the second molars and all porcelain on the first. He just did it.


Howard Farran: I have all gold and the difference is if you’re short, fat, bold and ugly just go all gold.


Steve Rasner: Stop.


Howard Farran: When you’re good looking like Dr. Rasner you will put some porcelain on that.


Steve Rasner: Oh yeah thanks you’re too kind, no and lying. Anyway so Carl Misch…the problem is and it’s no secret, Carl is ill so I don’t know how long he’s going to keep the institute open and I can only tell you what I know. I know he’s home run. 


Howard Farran: Is the institute still open now? 


Steve Rasner: It’s still open now.


Howard Farran: Do you think it will be open? 


Steve Rasner: I’m told it is. He’s still lecturing out there, here’s what to do, check it out. I mean I’m not going to lie to you.


Howard Farran:


Steve Rasner: Yeah is one place. I will give you two other names. The Salama brothers down in Helena, Maurice and Dave Garber, they are really, really talented clinicians. 


Howard Farran: They were all with Goldstein, it was Goldstein, Garber? 


Steve Rasner: They’re still together.


Howard Farran: They’re still together.


Steve Rasner: And they have hands on courses over the country by the way. The thing I liked about Misch is that he was very regimented. Well you went through it with me too, we literally went at the same time. I mean you know you go for five sessions, it’s every other month, you go for three days, you know there’s a lot of probably good ones right ones right now. You just check them out or run it by somebody on Dentaltown that knows about it or reach out to Howard or me or somebody.


Howard Farran: Can I say one thing about the Misch’s too because we were there together is, I was in my office and you know it’s two dimensional panos and you lay a flap and I just felt like…I just was in over my head. And then you would go see Carl, lay somebody down and just like make an incision from retro molar pad to retro molar pad and flay it all open.


Steve Rasner: Yeah.


Howard Farran: Place like eight in the lower and be done like in 30 minutes. So for me it was you’re trying to learn chopsticks on the piano and then you go and watch Beethoven and it somehow numbs you. It’s somehow numbs you to go back and then when you go back home placing a single implant you feel like you’re playing you know volley ball. 


Steve Rasner: Yeah.


Howard Farran: I mean it just numbs you when you see someone doing...It’s probably like when you got to war, when you come back and you go duck hunting does not to freak you out.


Steve Rasner: Yeah.


Howard Farran: So it kind of desensitized me for fear.


Steve Rasner: Mike Pikos are also in Tampa Florida is an oral surgeon that teaches GP’s and he is exactly like Strupp.


Howard Farran: Clearwater you said?


Steve Rasner: No he’s in Tampa.


Howard Farran: Okay.


Steve Rasner: He’s 30 minutes away. He has an institute to learn in and he is a gifted oral surgeon and by the way I always have to say this when I like them, he’s kind. I mean you don’t want…you know what you don’t want? You don’t want to go somewhere where everybody thinks they’re a hot shot. Have you ever been in a course, everybody seems to know more than you do on the first day. I always feel that way actually but that’s not what you want. You want to feel really free to ask the dumbest question you think is the dumbest question and not feel dumb when you ask it.


Howard Farran: What’s his website?


Steve Rasner: Pikos, just Google, Mike Pikos Oral Surgeon Tampa Florida. Unbelievably gifted as a team. He’s gifted and again when you’re in these courses…I remember telling you this and that’s what the cool thing about learning. When you’re in a course, like next year is going to be an endodontist learning…everybody is learning implants. The next guy is going to be a prosthodontist, there will be periodontists and oral surgeons and there will be a handful of GP’s ready to be superstars down the road. I’m telling you, it’s your ticket to remain independent. 


Howard Farran: And we are out of time and I just want to end on one note, it’s you named a lot of great clinicians and if you had asked me who is the greatest clinician that I know, it wouldn’t be Strupp or Pikos or Gordon Christensen, it would be you my man. You are amazing. 


Steve Rasner: Thank you. 


Howard Farran: Thank you for an hour of your time.


Steve Rasner: Thank you Howard. See you guys. 


Howard Farran: Alright thank you very much. 

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