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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168 Fighting Burnout with Tom Peck : Dentistry Uncensored with Howard Farran

168 Fighting Burnout with Tom Peck : Dentistry Uncensored with Howard Farran

9/29/2015 2:00:00 AM   |   Comments: 1   |   Views: 515

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VIDEO - HSP #168 - Tom Peck

Tom Peck, DDS shares what he learned from being in a group practice, and how he plows forward without burnout.



I'm a GP and 2006 Graduate from the University of Tennessee. I worked for Heartland right out of school for about a year in Central IL. In 2007 I joined a private practice in Plainfield, IL and became an owner in 2009. I'm a full time private practice dentist. My other interests include biking, running and bass guitar., or

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Howard: It is a huge honor today to be interviewing Tom Peck. How are you doing today Tom?

Tom: I’m doing good Howard and also happy belated birthday.

Howard: Thanks dude, I turned 53 Saturday and had a rocking, hot day. I had all 4 of my boys and my granddaughter, we all went bowling. Believe it or not, I actually won with a 127 and I don’t know if that’s because my boys were all drinking beer or if they let me win. It was an absolute blast. You’ve had an outstanding, interesting career. You’ve been at Townie since 2004 when you were still in school?

Tom: Yeah, I think I discovered Dentaltown when I was a sophomore going into my junior year. I graduated in 2006.

Howard: From University of Tennessee?

Tom: Yes.

Howard: I love that part of the country. God, that’s a beautiful part of the world. What would you tell dental students listening to this on iTunes or YouTube who have never been to Dentaltown? Why did you get on Dentaltown in school when you were still trying to learn physiology and anatomy and biochemistry?

Tom: Well my whole career has been post-Dentaltown so I have no idea what it would be to practice without Dentaltown. I'd probably be terrified because there’re so many things I learnt from Dentaltown. That if I started like ’95 or before Dentaltown occurred, I don’t even know how I would run a practice. Because they don’t teach you how to run a practice or anything and I’m trying to figure out how I learnt about Dentaltown. I think I found it through Student Doctor Network, you remember that?

Howard: Yeah, that’s still going strong, Student Doctor Network for med students, dent students.

Tom: Yeah, I don’t know what I was doing. I think I was looking for practices to buy or maybe I was just looking for a dental job. Somehow from Student Doctor Network, someone talked about Dentaltown and I logged into Dentaltown and I’ve been on it ever since.

Howard: That’s why I’m always thinking of hope, growth and abundancy. I’ve always thought it was funny how a lot of other websites or dental groups, they think in fear and scarcity. Like dental magazines, I don’t know any dentist that just reads one magazine. Sometimes you’ll be talking to a dentist and they’re like, “Oh, I’m aligned with another dental magazine.” “I’m like, “Well how are you aligned with a dental magazine? I mean, are you aligned with dentistry and 2 million dentists around the world?”

I remember when I was studying, during my MBA, I was reading Forbes and Fortune and Ink and Success and I read 5 different business magazines. I just don’t think in fear and scarcity. Then you came out of school and you got a job with Heartland Dental Care, Rick Workman. That is the largest dental services organization in the world. I want to ask you this, when I got out of school in '87 versus you 2006, many of my classmates thought, “You know what? I’m going to go get some experience and I’m going to join the army, the navy, the air force.”

Now a lot of times people say, “Well I’m going to get out and work for corporate dentistry, big, chain dentistry in multiple states.” A lot of people look at that and think that that’s controversial. I would think working for Heartland under Rick Workman, I would think you’d have to learn a lot about business and organization and management needs. I don’t see how that could not be a good thing.

Tom: It was great. Heartland, they were the only people that would guarantee a salary and that’s all a new grad wants. A new grad need to get out and we have bills to pay, we don’t know how to run a business. Heartland said, “Don’t worry about that, we’ll help you through that.” I moved from Memphis to the middle of Illinois, “There’s a practice for you.” I went to the practice before I graduated and it was fine. You’re exactly right, we don’t know anything in dental school as far as running a practice. They know how to run a practice and I went into it knowing that it may be short-term.

I don’t know if I was going to spend my career with them but I thought, “You know what? I’m going to learn as much as I can.” To be honest with you, I did. Their CE was tremendous, I got to meet Steve Buchanan, Dennis Tarnow. They brought like top, quality people to Effingham, Illinois. I couldn’t afford to drive out or go out to Santa Barbara and do all this. I had no money, so it was wonderful. I learnt how to do so many things and it was a guaranteed salary. Some people stayed with them and that’s great, but I knew I wanted to run my own ship. Then after about a year or so, we parted ways amicably and I have no regrets.

Howard: What were your takeaways from Heartland that they didn’t teach you in dental school?

Tom: Just running a business. What I see in Dentaltown is a lot of doctors they get out and they’re very clinically oriented which is great, but they shy away from running a business. Now one thing, if you see these guys with tremendous talent on Dentaltown but your practices are just paddling along. They’re barely making any money which ... you want to make a good income in dentistry because it’s hard.

You paid a lot of money to get into the field. Just by learning a couple things of business you could do so much better. I knew coming out of dental school that that’s a training I needed. I knew quite and clear I’d probably learn clinically how to do things but how to run a business, well no one really knows how to do that. I knew Heartland had a reputation of showing you how to analyze numbers, how to look at a P&L, how to calculate overhead. That’s what I needed, so that’s why I joined up with it.

Howard: When you left did you take a lot of their forms and systems and …?

Tom: I took all of it. They had a huge catalog and I basically went, I bought into a practice, I met with my partner I said, “I learnt a lot of systems and take a look at these.” He’s your age, he’s 53 and he goes, “Yeah, we can implement these, it’s not Rocket Science. They just systematized it.” I’m doing it to this day.

Howard: We have a download section on Dentaltown and it’s called downloads. I have all my forms that I used to run my dental office and a couple of people. I wonder if Rick would be opposed to uploading all the Heartland forms on there?

Tom: I don’t see why not. I mean Heartland gets a bad rep and a lot of people parted ways. It just wasn’t a good match but I think if people saw Heartland’s app like protocol. They’ll realize that the recommendations and how you runs things, it’s based on good clinical protocols, good business protocols. It’s nothing to be ashamed or scared of and I think these people just don’t know.

Howard: People get mad when the government steps in. The government always steps in when there’s a market failure and when Rick Workman stepped in, you had older dentists trying to sell these big practices. There was no buyer, so there was a liquidity problem. He’s the only guy who could come to my office there and just write me a check for my office, nobody coming out of dental school could do that.

Tom: He’s going [inaudible 00:08:01].

Howard: He’s what?

Tom: He’s the only guy.

Howard: Then you got this country where about 60% of the dentists went to 117 towns and the other 40% went to 19000 towns. The most reports are about 10 or 11% of these small towns don’t even have a dentist. Like Workman, he climbed around the back, rural areas and then all these towns you've never even heard of before. He is one of the largest suppliers of jobs for recent dental graduates. Here’s these dentists complaining about him and their office is there a 168 hours a week and they’re only open 32 hours a week.

In most of America you’re better off breaking your leg on a Friday, Saturday or Sunday because you know the hospital emergency room they open. Then breaking a tooth and you might just as well dial a prayer to try to get anybody to return a phone call or whatever. Then he comes in there and does business 101 really. I mean, I don’t see anything he did that the economist is saying, “Wow! We never thought of that.” Everything he does has been done in all these other industries and I think what it is, is dentists don’t like competition.

I mean if the dentists had it their way, they’d be the only dentist in America, they’d see one patient a day, they’d charge $1 million cash for the hour of visit in advance. Then they would think in their own walnut brain that it’s a perfect world. That the only thing that is perfect in business is to think of what your customer needs are, to be dentist-focused. You’ve posted 5000 times, I want to thank you for that. Are you just hard-wired to share?

Tom: I think so, I don’t know why. I think I’ve been sharing ever since I joined. I don’t know, maybe because I don’ have a … what do you call it? A mute point. I just hit, reply and type something. 90% of the time is probably not even helpful but it’s just a reaction.

Howard: Every time I go lecture I say, “How many people are on Dentaltown?” Probably 80% of the hands go up no matter what country I’m in. Then I say, “How many of you have ever posted 1 time?” Like 2 hands go up. I think what it is, is I think that social animals are just afraid to be noticed and they’re afraid to ask a silly question or they’re afraid they might be wrong.

What advice would you give? I would assume 95% of the people listening to this have never posted either. You were posting as a kid, you were posting as a dental student and these guys have been out 10 years. What advice would you give to our listener who’s on Dentaltown, who’s afraid to just post? I mean they should start with just posting the letter 1.

Tom: Yeah.

Howard: I mean what advice would you give them?

Tom: Just get used to posting. I guess, don’t worry about saying something to offend someone or don’t worry about … Just don’t have any ego, if you have a question, ask it. I’ll get private messages asking me and I’ll say, “Well just start a thread.” They’ll say, “Well I don’t know how to start a thread.” Then I’ll just say, “Hey, I’ll start a thread with this question and then you respond to it or see what they say.” I think dentists are just really reserved, they’re introverts I guess, so you can’t blame them.

Howard: The other thing I don’t like, I can’t even count how many private messages and emails and everything I get every single day. It’s about 300 a day and I always think of myself, well first of all it’s selfish of you to ask me and want me to just answer your question. That’s selfish. Number 2, it’s also wrong because why would you think I know all the answers. Whereas when you ask this in a community, if you said, “What is 2 plus 2?” I said, “5.” Well there’s 202000 other dentist that’ll say, “Hey Howard is 53 years old and senile and it’s not 5, it’s 4.”

Then the debate can continue but the thing that’s awesome is everybody learns and grows from your question. When you ask a private email or private deal, I mean it’s selfish because you’re just taking. You’re going to a community and you want to take individual advice instead of starting a thread and sharing so that we all learn from your question. If you had the same question, out of 202000 dentists, how many others have the same question?

Tom: Yeah, it’s amazing they’re all asking the same question.

Howard: I’ve never heard a unique one.

Tom: No, it’s all-

Howard: Even when they end up in jail, it’s the same scenarios. They can’t even go to jail uniquely, you know what I mean? When they lose their license it’s not unique and sometimes people get mad at me when I post about someone going to jail or this or that. The reason I do it is I’m not trying to out somebody because they went to jail. I think a lot of people need to be reminded you can’t write prescriptions for your staff. That’s when they get in trouble. Even when the guy was putting a secret camera in there, when that one guy got busted with a secret camera in the staff’s changing room.

I bet out of 202 dentists, if one guy got arrested for it, there had to be I’m sure, one other person doing it. You could read that and say, “Maybe this is really a dumb idea. Look at this guy’s picture posted all over the internet and newspaper.” I think you need to share the good, the bad, the ugly. My favorite lecture of all time and I’m so upset that I can’t remember this right off the top of my head. He was a prosthodontist and usually when you go to lecture and everybody shows the best case.

They’ll do 100 implant cases and 100 cosmetic cases, they’ll just show this 1 or 2 chariot pit case and make everybody in the room feel bad. He would get up there and he’s say, “You know what I learnt the most from my failures?” He goes, “I’m just going to show you every horrendous mistake I’ve ever made.” Then he’d show 30 years of implant failures. I just thought, “How much self-esteem do you have to have to post all your failures and then to share the lesson of what you learnt from those failures?”

I always say the best foundation is when you hit rock-bottom and sometimes … I was talking to an implant instructor and then he says his best student are the ones that tried implants for 3 or 4 years, had some big failures, they finally said, “Forget it.” Quit doing them for a year or 2 and now they’re back. Those are often times his best students. What advice would you give to the dental students who are listening to you right now? They’re third or fourth year dental students, maybe they just graduated. What advice would you give them?

Tom: Keep your debt low because you guys are coming out with double the debt I had. I graduated '06 from a state school, I was an in-state resident and it still cost be about $130000 to get my degree. Well if you look at the-

Howard: You mean 130000 in debt?

Tom: In debt.

Howard: Okay, because you probably paid another 130?

Tom: Yeah, I mean I don’t-

Howard: You were in the whole 130?

Tom: Yes.

Howard: When you were in dental school did you buy a car on student loans?

Tom: Of course not, no.

Howard: Yeah, they do it all day long in dental school. You can’t find a dental student that doesn’t have $30000, new, Japanese car paid for on student loans. Did you ever take a cruise on student loan debts?

Tom: Never.

Howard: Did you visit a foreign country?

Tom: Yeah, we did take a cruise I think senior year but I think my wife … came all through school. We slept down in the engine room but it still worked. I don’t know, it was like a few 100 bucks.

Howard: I think I saw you and your wife on the movie Titanic.

Tom: Yeah, I was holding on to that door thinking.

Howard: Okay, so keep your debt low, what else, advice would you give them?

Tom: Well do what I did. If Heartland’s hiring, go work for a year. I mean, they’re going to send you to all the CE … I mean some guys stay with them and they have good careers but maybe go in there knowing, “Hey, I’m going to give this a year, I’m going to learn as much as I can.” Treat it like a real world … job. You’re learning the business, you’re going to learn how to clinically do stuff. Because everything that walks in the door, if you feel comfortable doing it, you can do it. A year working there, I felt confident doing all sorts of things. I really was ready to start my own business.

Luckily I came across a practice in an area I wanted to live and it worked out well. That’s what I’d tell a new grad or another thing I would say is your first 5 years, you don’t know what you want yet, if that makes sense. Work in a big practice, work in a small practice. It took me at least 5 or 6 years to … If you talked to me 5 years ago I would have said … this is what I’m striving for. Totally different today, you just don’t know what you don’t want. When you come out of dental school, don’t have your mind set on a style of practice that you want to aspire to.

Howard: I think all the greatest minds that ever lived would say that every 5 years of their entire life, they’re thinking newer thoughts. A lot of their older thoughts, they no longer believe. I mean I look at protocol for everything from a root-canal filling to crown, I’ve had to approach my own 4 children to how I approach my granddaughter, HR, I mean everything. I don’t think I’ve ever been at a landmark birthday and looked back 5 or 10 years and thought, “Wow, I can’t believe I used to think that.”

Tom: Yeah, that’s for sure. It’s humbling. Yeah, it’s always changing.

Howard: That’s what I also love about having a monthly column every month since '93. You get to see, “Wow, I thought that in 1993. Wow, I thought that in 2003.” Look at your post, I mean you’ve got 5000 posts, I’m sure every once in a while you see a thread come back alive and you think,  “Wow, I posted that 5 years ago and that’s what I thought?”

Tom: Yeah.

Howard: That’s why I always tell people, if you’re going to quote me, date me.

Tom: [Inaudible 00:18:50], yeah.

Howard: I mean I’ve seen some of the craziest quotes where people are quoting me from 1993 and I’m like, “A little bit has changed since 1993, lots of different paradigms.” You’re in Plainfield, Illinois?

Tom: Yes.

Howard: Is that a suburb or something else or is that?

Tom: Yeah, I’m right in the middle of a suburb here. It’s a suburb of Chicago, I’m about 40 minutes by car to get to the Chicago loop.

Howard: Tell us about your practice and what type of dentistry are you doing that you learnt from some of the continuing education courses that you were entitled to at Heartland?

Tom: Let’s see, I got really good at molar endo. Right when I joined the practice I was doing a lot of molar endo, a lot of extractions. At Heartland I did a lot of extractions, I did a lot of surgery. To be honest, once I came to suburban Chicago and over the years, my practice has really matured to where I’m just doing a lot of restorative to be honest with you. A lot of crowns, bridge and restorative. A lot of people say, “Well that sounds boring.” What I’ve come to figure out is you can get your thrills out of doing a bunch of different clinical procedures.

Like I’ve placed implants before, I still place them on occasion, I don’t do a lot but I get my thrills on the business aspect now. I got a core of procedures I like to do so I don’t get too stressed out to that side and I get excited when we’re trying to figure out how to improve the business, how to improve customer service. That’s what I’m excited about right now. Now talk to me in 5 years and I might be telling you, “Yeah, I want to learn how to do sinus lips or something crazy.” That’s where I’m at right now.

Howard: How old are you?

Tom: 36.

Howard: There’s a lot of dentists in Chicago.

Tom: A ton.

Howard: Illinois has what? 3 dental schools?

Tom: It used to.

Howard: It used to have 4.

Tom: Yeah, now there’s-

Howard: Northwestern closed down.

Tom: Yes, Loyola closed down, so now we have one in the South part of the state, SIU. We have one, University of Chicago in downtown Chicago and now we have Midwestern University which is in a suburb. I think that’s related to [inaudible 00:21:28]-

Howard: Linden, Arizona.

Tom: Yeah.

Howard: No, Midwestern has one in Linden, Arizona which is about 30 miles North of me. It is still is in Mesa, Arizona and I think they’re founding schools in southern Missouri.

Tom: Okay, so they’re different.

Howard: Northwestern closed down, Loyola closed down. Do you think that Chicago has the right amount of dentists? Do you think it’s saturated? Do you think it’s under-saturated?

Tom: No, it’s super-saturated. Every major city is saturated, it is but that doesn’t stop you from making a decent living. We’ll go on a different tangent, a lot times I’ll post on the threads of some of the older dentists that are getting upset that they’re mad that PPOs are moving in. They’re mad that corporate dentistry is moving in. They’re just mad that there’re so many dentists. Okay, you can be mad but you’re not going to be able to control that, you’re not going to change it.

What are you going to do? What I’ve learnt is a lot of those outside forces that people are threatened by, you can learn from them. They’re not doing anything out of the ordinary like what I learnt from Heartland and corporate dentistry. Like you said, they’re willing to do a lot of stuff that are more patient-centered like, I’m open on a Saturday and it doesn’t bother me. I’ve worked at it so much that Saturday is a workday for me. I work till noon, it’s not a big deal to me.

If you tell a guy in his 50s that, “Hey have you ever thought about opening on a Saturday?” They’ll be, “Oh, absolutely not.” Most people will work till Thursday, at Thursday at 5:00 they’re done until Monday. I’m, “Okay, doc if that’s the way you want to do it. If you want to have a banker’s hours then you can’t really complain if you’re getting slow and someone’s moving in and willing to work 12 hours.”

I mean it’s not as easy as it was in the 80s or the 70s or whenever the heyday was. I guess what I’m getting back to is, even in the crowded areas if you try to be patient-centered, if you try to accommodate them. Yeah, the lifestyle of a dentist is going to be a little … you can still be successful. It’s still a good profession. Even in suburban Chicago where you can’t swing a dead cat with a hit and a dent.

Howard: I think what the funniest thing is you ask a dentist, “Would you consider yourself dentist-focused or patient-focused?” They are, “Oh, my extremely dentist-focused … I mean patient-focused.” “What are your hours?” “Monday through Thursday, 8:00 to 5:00.” “Okay, when do you take a lunch?” “12:00-1:00.” Okay the Federal Reserve has more economists on the payroll than any institution in the planet and they say one-third of Americans cannot go to the doctor during Monday and Friday 8:00 to 5:00.

The only time they could even call your office is their lunch-break and you’re closed. What consumer-oriented practices are you excited about or are you thinking about right now, that you think make a difference? That give yourself a unique selling proposition? As Warren Buffett says, “A business shall have a protective mode around your business and maybe a pattern or a brand name that’s huge.” What are you excited about that differentiates you from an over-saturated market?

Tom: That’s a good question. I’m still trying to work on a brand, it’s always a work in progress but I’m trying to figure out what my market is. Right in the middle of suburban Chicago my market is soccer mom, it's mom and the kids. What I’ve done is I’ve tried to build practice where you can bring in all 4 kids at the same time. We will see them all at the same time or we’ll see 2 hygienists, we’ll have 2 of them back at that. That’s what I try to carter to that we’re trying to be family oriented. Another thing is taking PPO.

I will take your PPO, I mean around here you have to if you want to be viable. There are some people that say after a while you can win off of them, I don’t know if I’ll ever win off of them. I try to follow your model. What is your model? Faster, higher quality, low in price. I learnt that back in 2004 from reading your columns so I’ve always tried to keep that at the back of my mind. Yeah, you can keep raising prices but you’re dollar-wasted, you’ll go about it. Okay, so we talked about cost, we talked about patient-commitment.

We’re open till 7:00, 3 days of the week. My hygiene department it’s hard to get in so we’re going to open maybe another evening. People like the evenings, people like the Saturdays. There’s 1000 things I could do to be more customer-oriented and maybe that’s the exciting thing, I’m still learning about it. What else can I offer? We just instituted Lighthouse, Lighthouse sends a survey that says, “How was your experience?” We get instant feedback and then I had them add a question that said, “Is there anything you would want Plainfield Dental to do or the acrobits to do? What would it be?” I had them include that question because then I know what my patient … Then it’s easy, then you just steer yourself towards that.

Howard: Okay, explain Lighthouse again and give some names of other similar products and why you bought that? Why did you pay the money for that and what were expecting it to do?

Tom: Okay, so Lighthouse it’s like a man-force, it’s a bunch of other different companies. I work with Lighthouse purely from Townie recommendations. I was using [inaudible 00:27:23]. After reading all the spreads about these automated, recall reminder, that’s what Lighthouse is. Lighthouse sends a free text message to all of your patients, they’ll even send postcards. It’s customizable, however you want to contact the patient. They will contact in 2 weeks from their hygiene appointment; the day of, the day prior. It’s all customized. That’s all Lighthouse is and Lighthouse also does-

Howard: How much did you have pay? A big fee upfront or just a monthly fee or?

Tom: No, it’s a monthly fee, it's once a month. There’s no contracts and it's-

Howard: You know what the monthly fee is?

Tom: Yeah. We bought a lot of stuff all at [inaudible 00:28:15], like they send out postcards, so that’s additional. I think for the standard-

Howard: Postcards to remind the recalls or postcards for new patients through the zip codes?

Tom: No, I think they might offer that second thing but no, just current recall patients. We still send a card and we have Lighthouse do it. They send them an appointment card and they’ll do automated phone calls and they’ll do text messaging which our patients love. I don’t want to misquote them, I think it’s like $300 or something a month.

Howard: That includes the postcard or the postcard’s separate?

Tom: No, I think we might pay a couple of 100 buck a month for all the postcards.

Howard: Why do you pay money for paper and snail mail postcard as opposed to email and text? Do you just find a higher response rate or? What are your thoughts on that? Did you try it with the postcard versus email versus text? I mean what was your-

Tom: Howard, we were still paranoid about this that we hired Lighthouse because we were sending the patient text messages, Lighthouse is sending them a postcard and my own front desk was sending them a postcard. Almost like a back-up. After 6 months I said, “Okay, everyone is getting a message about the recall appointment.”

We cut out my front desk sending out post cards and the reason why I send postcards, I get a lot of older patients. A lot of them they don’t have emails so we still like to send something, a paper. Something in the snail mail. Talk to me in a few years, we may have curbed that by then but we just feel more comfortable. Like recall from my practice is the life-blood, so we’re always sending those patients something.

Howard: I believe in my gut that 50% of emails go into spam filter, junk box, whatever. I believe that Monday through Friday, 8:00 to 5:00, when you send your patients a text, I mean they’re all received and answered or replied seriously within 10 minutes.

Tom: Yeah, we’ve noticed that. Yeah, texts are great. A lot of times my email mail box, I click the all and I delete it because I just get so frustrated of all the spam email. You’re right, I like the idea of text messaging. That’s been really good for the suggestion, for-

Howard: That’s why you don’t reply to my emails? You hit the select all and delete them all. I want to say something about PPOs and dental schools. A lot of dentists complain about how many dentists are coming to dental school and then a lot of them complain about PPO. They both fall in their price listing and that is price has a very lasting effect on demand. As the price goes up, the demand shrinks. Obviously you’re going to sell a lot less Lamborghini at 300000 but as you lower the price to a Cadillac of say 100000, you’ll sell more.

If you lower it to a Ford Escort of 15000, you’ll sell a lot and 70% of cars sold are actually used cars. Dental schools are all reporting the same thing. Every time a dental school raises the price of their tuition, $10000, they have no noticeable difference in the number of applicants for the next year. They figured this out about 10 years ago, they go, “Why are we short on everything? Why do we have all these debt when we say dental school is 50000 and we get 5000 applications? Whenever it’s the 60 they send out 5000 applications."

Now a lot of them are at over 100 and still going higher. Another thing is a third of those dental students, their dad’s a rich dentist. If daddy wants junior to be a dentist, he doesn’t care if it’s $100000 a year, he just wants him to be a dentist. On PPO it’s the reverse. Every time you lower the price of a procedure, more Americans can afford it. Henry Ford said if you make an expensive product for the classes you’ll be poor and you’ll live with the masses.

If you make a product faster, easier, higher quality, lower price and you aim for the classes, you’ll get so rich and live with the masses. Here’s the scenario I see with the PPO stuff that I argue with on some of my friends when we’re out there biking, swimming, running and whatever. They’ll say, “Well I have to get 1250 for a crown or I can’t do it.” Yet they’ll schedule 90 minutes for a crown with the old technique and impression lab, whichever. Then someone else will sign up for a PPO and do a crown for 900 but they can do it in an hour.

It never dawns on the dentist that, “Okay, when you need 1250, you see the patient and then you walk in there and you numb them up. Then you went back to your office and called your wife for 15 minutes. Instead of I’ll go in, I’ll numb, I’ll set a timer for 4 minutes, I'll use septocaine. Then after 4 minutes you can take an impression if it’s temporary and take the shade of the crown. The assistant can load up the Isolite so that she can still be doing a lot of things. Then 4 minutes then you’re propping the crown.

Then a lot of dentists say, “Well I believe in expanded functions so I’m going to leave the room and let my assistant. Because I’m expanded functions, I delegate. They’ll leave the room and they won’t come back for 15 minutes because the assistant packed a code. I mean you can pack your own code in 60 seconds, new gloves, new mask, whatever. I mean I can give you the name of 100 dentists that can knock out a pinky, prep crown, impress it and temporize in 30 minutes. When you what is expected for a PPO, does it ever dawn on anyone that maybe you’re slow and lazy?

Say you can’t politically correct it, you can’t have a bunch of people come to the core and say, “Hey auditorium filled with people, a lot of you are just slow and lazy.” It’s like working out with a personal trainer. When I go by myself I literally start walking on my runs. When you’re with a personal trainer, they’re just on you the whole time, “Come on, pick it up. I want you to give 100% all the way to the stop sign.” They’re just pushing you and a dentist owner doesn’t have anyone pushing him or her except the little birdy on the shoulder or maybe this podcast.

Tom: You’re right.

Howard: How many hours a week do you see patients?

Tom: Let’s see, we open 8:00 Monday till 7:00, Tuesday … until 5:00, Wednesday we work 8:00 till 5:00, Friday 8:00 till 5:00, Saturday 8:00 until noon, whereas changes become possible.

Howard: Do you have an associate?

Tom: No, I have a partner but depending, an associate maybe in the works. We’re not sure yet.

Howard: Tell us about your partnership, how is that going on? How long have you had a partner and what is that like? Because we know that 50% of marriages all fail and that is when you have sex, children and spending evenings or weekend together. How is it being married to another dentist?

Tom: It can be tough at times but the advantages are a lot worth it. You have someone who’s similar to you as far as … Let’s say I wanted to take PPOs and he didn’t, well you guys don’t have the same philosophy. It’s not going to work. Luckily me and Pete my partner are very like-minded. We both grew up just middle-class kids in the Midwest, we had the same values, we both work hard, we don’t have really expensive tastes. We go on vacation together, I mean we are generally friends, not that you have to be. It’s been working out very well.

I knew I wanted ownership of something right out of school. I worked at Heartland for a year, then I matriculated into this practice in Plainfield. I only worked about a year before we hammered out details of the partnership that I nearly bought half. If it will be paid for, then we’ll be full 50-50 patterns and then the strategy is I must find my replacement. 

Howard: Pete’s an older, existing dentist?

Tom: Yeah, he’s your age.

Howard: He’s still alive?

Tom: Yeah.

Howard: My gosh! Does he have an artificial heart or? Anyway, so he had an older, established practice. Why was he looking for an associate partner? Was he ready to slow down and wine down a little bit? Does he work less hours than you or what was his needs?

Tom: He had a few associates … “I need someone that won't wreck it. I don’t want to practice alone, I don’t want to be the only boss. I want someone else to help with the administrative stuff, hiring and firing people, things like that.” In 2004, the senior doctor, he retired so he was running a 2-doctor practice all by himself. Then he had a couple of associates but they didn’t really work out. I met with him, we hit it off, he said, “Hey, I don’t [inaudible 00:38:09] associate, I want someone to come in and buy this thing from me eventually.” That’s exactly what I wanted.

Howard: I think partnerships and marriages work a lot when you have different interests and skill sets. It sounds like he wanted to be a clinical dentist but really didn’t want to run the business. He got in in a practice with an older dentist who was running the business. Then that guy retired and he got that dumped in his lap and he thought, “I don’t want to be that guy. I want an associate that’s going to buy in, stay and help with the hardest part of any business which is people, HR, attracting and maintaining key, quality staff.” Which will never end for your favorite Anfield team and it will never end for your dental office.

Tom: No.

Howard: The minute you knock on wood and say, “I have the best team ever in the history of my world.” The minute you say that, someone’s going to move out of the state, find that new lover or get divorced or whatever. Just because you won the super ball, it’s no guarantee if you’re going to win it next year. In fact I would love to see statistics of if you win the super ball, what the odds are of winning it again next year. I mean all you got to lose is a couple of turns and a couple of players, a wide-receiver or a running-back, a quarter-back and you have an all new team.

Tom: Yeah, you’re definitely right. That’s why even in dentistry you always … I learnt a good term from another Townie, he said, “This is actually subsiding because it’s September. Everyone’s complaining about the September slope fall.” Well he fell a while back, he goes, “That’s why you always have your foot on the gas.

Even when you’re having a really good month, you make that month even better. Then that way, you get through September.” That’s like staff, you don’t just rest on your holes, you’re always looking at your business. You’re always thinking about if everyone doing their job. I guess don’t just assume that everyone’s going to keep performing at their best. We always got to motivate each other.

Howard: You’re in Plainfield, Illinois? Isn’t that where MacDonald is headquartered?

Tom: Not far, Oak Brook. About 30 minutes from me.

Howard: About 30 minutes from there. Because Ray Kroc bought the original 10 McDonalds from the MacDonald’s brothers but he was the one who made it what it is today. That’s what he said in his book 'Grinding It Out: The Making Of McDonald'. One of my biggest takeaways in that book is he couldn’t believe how during the recession everybody would slow down their expansion plans. He’s like, “Are you kidding me? Land’s cheaper, everything’s cheaper. You have a bigger talent pool.”

He would always hit the gas the hardest in a recession and he said, "That is my best break-out sowing a dip." Warren Buffett, every time the stock market crashes he says, “Oh my God, the stocks are on sale, buy.” I call that to my team a start-up mode. 28 years on the business I’m mostly always telling my staff that was there on date one, “Look how hard we were doing and how much effort we were giving in those early years. Why can’t we give that much now?”

Like Dentaltown, when we launched that in '98, it was literally around the clock for a year trying to get that thing up and running. I would say, “Come on, stay in start-up mode. We’re not the post office, we’re not the IRS, let’s not settle down to that 40-hour a week cruise control. I love it when I’m seeing a barrage of emails from the staff in evenings or weekends or something. Because they’re passionately trying to put out some fire, do something or launch something new or whatever. I love to see that start-up mode.

Tom: Yeah, I like that too.

Howard: What’s got you excited now going forward?

Tom: For the first time ever, I realized I can’t do this all on my own, we’re bringing in a consultant. We’re really excited, we’re going to see what she has to say, I’m going to have her review all the systems. We’re really excited, I guess in week or 2 I think is the first meeting.

Howard: Who did you choose?

Tom: It was a recommendation of another Townie that’s doing very well and I went out and visited him. He said, “This woman helped me very well.” I got in touch with her, her name is Theresa Narantic, she works for Clue Dental Marketing. Do you know her?

Howard: Yes.

Tom: Okay, great. She’s fabulous, she was really nice and we’re going to get started with her shortly. I’m really excited because then I’m tired of figuring out all the answers on my own.

Howard: Spell her name for us, Theresa Narantic?

Tom: Theresa, t, h, e, r, e, s, a. Narantic, N as in Nancy, a, r, a, n, t, i, c.

Howard: N, a, r, a, n, t, i, c?

Tom: Yes.

Howard: What’s her website? Is it

Tom: I honestly don’t know. I think if you just typed it in the Facebook she’ll pop up.

Howard: Okay, now I want to say something about consultancy. I mean the absolute best offices I’ve ever seen and I mean some of them are like … I would just have to say are perfect. I don’t want to drop any names because I don’t want to embarrass them and I might get back to it like Jerome Smith and Lafayette, Louisiana. That’s a joke but I brought in Sally McKenzie the day I opened. I brought in Sandy [inaudible 00:43:52].

I’ve had 2 consultants in in the last 2 years. The way I’ve been consulting, a consultant comes in and you give them a dollar and the end of the year you get your dollar back and a penny or more. How is that not a smart deal? I’ve always seen that the ‘do it yourself first’ never get it done. They just sit there and wallow their whole life. Dentistry is such a small community with Dentaltown and it’s such a small community. When you show me any single consultant that still have the power.

You can’t be a dentist for 25 years in a small town of 5000 and not be helping someone. I mean somebody is coming back to you and they all have different opinions, they all have different philosophies. I look at them all as cafeteria and the other thing is the staff responds so well to anybody 100 miles away from home. When I tell them something it’s like, “Well you’re just stinky, dumb Howard.” When someone comes in and they’re in a suit and tie and they got a presentation, it opens up everybody’s mind and I just love it. I think all the successful dental offices have had consultants.

Tom: Well Howard I was going to mention, I think today we’re going to talk maybe about issues with burnout. I think an important thing is I thought, coming out of school, I was going to try to do it all myself. Just like you said, the top practices, the guys at Dentaltown that are doing really well, don’t think they did it all themselves. They had help. Well I was so stupid, I didn’t realize until about 5, 6 years in my career that, “Oh, yeah they hire outside people to help them get to this level.” Don’t pull your hair out and stay up at night trying to fix all these yourself. There’s people out there to come in and help you.

Howard: Talking about burnout, I know you want to talk about that. What are your thoughts on burnout? How big of a problem is this in dentistry? How do you think you’d treat it?

Tom: Well I think it’s a huge problem because I see it in my partner. He worked really hard in dentistry, he worked a lot of hours. He was scared if he wasn’t there, he wasn’t going to be able to save the emergency so he worked a lot. I guess not to a point of paranoia but he was just very concerned about the office. His office always came first and that is right. As a small, business owner that’s your baby, that’s your life plan. You don’t do yourself any good if you don’t take some time off and if you don’t recharge the battery.

You got to get out of there. What I’m looking to do is I’m looking to come up with systems to where I can take more time off. I’ll bring someone else in there that wants to work. That they want to come in and they want to treat patients. I don’t need to be there 6 days a week. How much money do you need to make? Once you cover your debt, your expenses, if you get a successful business, you can afford to take some time off. That might just be taking your kids to a … just stay local, have a state vacation, go to the pool.

If you don’t put it on your calendar, it’s not going to happen. I think my partner would be just as successful if he took more time off. Okay, another thing I want to talk about is you don’t want to hold yourself up to someone else at Dentaltown because everyone practices different. Don’t look at someone else’s practice and think, “Oh, that’s a great match for me. I’m going to strive for that.” That’s what I said, it takes you 5 years or so to figure out what you like. If you don’t like taking out teeth, then don’t do it. Like you have a good phrase, what was it? Don’t trade time for money and don’t take a procedure for money.

The fact that I focus on things that I really like doing and I don’t have to walk in, I got 150 pulse and I’m like, “Is this going to work out?” I’m not a cowboy anymore, I don’t need to do that anymore but some people like that thrill. Personally I don’t, I may want to do that later but it’s stuff like that. You have to come to work and do what you want to do. Don’t drive around the practice a few times and then finally go and pack. You should get up and realize, “I’m going to work but I don’t mind going to work. This is going to be pretty fun. I like my staff, I like the stuff I do. I’m going to design it to where I don’t dread it.”

Howard: Look at little kids, they’re so happy and they want to play in the sand box. The biggest thing I know is from my four little boys, is sometimes a dentist friend might have a kid but my kids didn’t like that kid or they didn’t play well together. It doesn’t mean that’s a bad kid. Just so many people that I’ve had to let go of over the years. I mean it’s not that you’re bad, it’s just we have these team, we have a psychology and you may be the best player on the raters.

This is the Kansas City Chiefs and you just don’t really fit in, I mean offices have different cultures. The other thing, the key I’ve noticed is that people still don’t treat their brain like their bicep. You’re an average biker, runner, bass guitar, I see people they wake up with coffee and then all during the morning they’re eating a doughnut. Then lunch is Tinkerbell, then they come in the afternoon, they’re snacking on cheese nuts.

Then after work they go to Happier and guzzle down some Kerosene and then they talk about how they have disease, depression and burnout. Before they go to bed they take a little pill and it’s like, “Oh my God.” Maybe if you woke up in the morning and started with an hour of amazing exercise and then an amazing meal. Maybe if you just adapted a lot of healthy lifestyles, your brain would be happy.

Tom: You’re exactly right, yeah. Try to work out every day if you could.

Howard: I got a friend who quit running because he was getting arthritis and his doctor said, “Dude look, you’re 6 years old, you’re beating up your body, you got to go running.” He quit running for 6 months and he was stressed and it was overwhelming and he said, “Forget my skeleton.” He goes, “I was running for mental health and I don’t even care about my skeleton anymore.” He resumed running and he said he’s much happier and healthier and he’ll have to let the orthopedists figure out what they’re going to do with his 212 bones. He put his brain before his bones and said, “I can’t quit working out. The endorphins is what relaxes me and keeps me sane and keeps me happy and all that stuff.”

Tom: Yeah, you’re exactly right. That was Jerome, right?

Howard: Yeah, it was. I wanted you to say his name, I didn’t want … I already said his name first, Jerome, a lot of consultants has been in his office. They’ll tell you of all the offices they’ve ever seen, 60 year old Jerome, it’s just the most perfect on every level from A to Z. He’s just an amazing man and he’s doing it right there in Lafayette, Louisiana. You put Louisiana, Alabama, Mississippi, Kentucky, you don’t think of the leading edge, high-tech, dental offices. That’s where it is Lafayette, Louisiana, he’s just crushed it. What a great guy. I only got you here for 5 more minutes, what else did you want to talk about for 5 minutes?

Tom: Good question.

Howard: What is biking and swimming and playing the bass guitar for you? We’ll start with the bass guitar, why do they spell it like the thought like the bass fish. I’ve always wondered that about bass guitarists, they can’t even spell the name of their own instrument. Shouldn’t it be b, a, s, e guitar? How do they get bass?

Tom: That’s a good question, I don’t know the history. Maybe we should call the fish, bases.

Howard: I love bass fishing. Do you think playing music and biking and swimming adds to your overall mental health? When you go to the dental office, you’re better?

Tom: Yeah, I have about 3 amps in the office and about 3 or 4 guitars. If I have a cancellation or somewhere where I got some down-time, you’ll probably hear some music coming out of the back room. You got to have some other interests. I mean some people are wired to dentistry is all they want, which is fine. I like other interests, so if dentistry beats me up that day I can go jam on the guitar.

Howard: You jam on the bass guitar?

Tom: Yeah, slapping the bass Howard.

Howard: Slapping the bass? Who’s your favorite bass guitarist? Is it Sting?

Tom: Yeah, except from a movie. If I listen, I get it.

Howard: What movie was it?

Tom: Let me see if I got your reflection here?

Howard: Yeah, I’m here, I hear you.

Tom: Can you hear me?

Howard: Who’s your favorite bass guitar?

Tom: Okay, Flee from Red Hot Chilli Peppers. He’s my far most favorite, he’s awesome.

Howard: I got to see him in row 4. I felt like I could hide … 

Tom: Really?

Howard: He has a tattoo on every one of his fingers. I watched it the whole night, unbelievable.

Tom: That is awesome, yeah. I love him, he’s awesome.

Howard: I want sit there and say that one of the best business lesson’s I ever learnt was from that movie 20 Feet from Stardom. Did you see that movie?

Tom: No, what’s that about?

Howard: Oh my gosh, it was so amazing. They gave this lady and she entered the music hall of fame. That’s what stirred up everybody’s curiosity because nobody had heard of her. They started looking into it, “Well why did you give it her?” Well it turns out that one of the secret recipes for the biggest bands in the 70s. Whether it was the Rolling Stones, whether it David Bowie, just the biggest names you can think of.

They said they would go in the studio and they would play their songs and it was nice but then they would bring in some of these Southern, African-American women who grew up singing gospel in churches. They would bring in these back-up singers, that’s 20 Feet from Stardom and the entire song would just explode. Then they were interviewing these back-up singers, “It’s just totally our culture.” She’d say.

Well most of the back-up singers were what we call sheet readers and they’d go in there and they’d read the sheet. Then most of the artists were low self-esteem and would say, “You’re too loud and you’re back-up, blah, blah, blah.” They said, the really high self-esteem people like Mick Jagger, that if you just started over coming him, he would literally walk back away from the mic looking at her like, “Men, take it.” Like on the movie … I mean the song Give me Shelter, you don’t think of Mick Jagger, you think of that black chick just crushing it.

Tom: Doping it up, yeah.

Howard: Oh, my God. That’s what it is in dentistry. When you have the staff and you don’t delegate to your assistant you don’t let your high-dentist run free. You’re always micro-managing and stifling and suffocating. Your biggest, favorite, rock bands were master delegators and these chicks were the greatest singers from the 70s and 80s. It’s a shame we don’t know their name and 20 Feet to Stardom went to these people and interviewed them.

The takeaway lesson was then, whenever I have hired and try to hire an employee … I’ve got around 50 people working for me right now, I always try to find people that are smarter than me, think creatively. I always have to remind them all the time. We were always at a meeting and so many people will say, “I mean it’s your call, you’re the owner.” No it’s not my call, there’s 5 of us here. You should get 3 out of 5 people. I think one of my biggest, successful, vigorous piece is attracting and retaining great people and staying out of their way.

I think I have about a 20-year track record of letting them go on 95% of the decisions. They will vouch that, Lorrie and Jean will agree. Many times I say, ‘We’re going to buy Red and we’re going right.” They go, “No, we’re going with blue and we’re going left.” I’m like, “Okay.” I also think figure as a leader, if I can’t sell it to really good, smart people, maybe I’m wrong. I mean, I need to go back and sell it better or get better prepared for my presentations or get more threads or more dentists talking or whatever. Looking back after 28 years of business, I mean the team has made all the right decisions, I haven’t.

Tom: Yeah, you’re exactly right. Then it’s easier for you, just get out of their way and let them help make the decision. I like that.

Howard: Yeah, I think it’s absolutely insane. Back to burnout, I just have to say one thing on burnout. When you give people money, that you don’t want to stand in the same room with, you’re going to end up drinking, smoking, eating Vicodin for breakfast. I mean you don’t give someone money who makes you miserable.

You find people where you say, “Men, I like giving you money. Because you get it done and I love your energy and I love your karma and you’re functional. You’re not being weird and blah, blah, blah.” Just don’t give people money that you don’t like and don’t do a dental procedure that you hate. If you hate endo, stop it. Because if that makes you burnout and quit and retire at 55 instead of rocking until you’re 75, you just lost $5 million dollars because you’re trying to make money doing endo.

Tom: There you go, that’s probably the most important things you talked about. You got to set it up for the long haul.

Howard: Success is a marathon, it’s not a sprint. Most people, even Warren Buffett will tell you he’s made more money between the ages of 70 and 80 than he did from 20 to 30 or 20 to 40 or 20 to 50. When you’re young, you’re tired, you’re just spinning and your car is going in 8 different directions. Then you finally get that car on the highway and you’re going down.

Then you’re my age, 50, the car just keeps going faster and faster. Now at 50 I can start to see the potential of how fast this car could be going in 10 years from now or 20. Pace yourself, hang out with people you like, do things that are fun. Do not do things you hate for money. That’s why hookers are usually on substance abuse because they hate their job. Don’t hate your job, be happy.

Tom: Exactly, I agree 100%.

Howard: Dude, thank you so much for your 5166 posts. I feel like you’re my long lost brother with hair. I really do, I feel like we’re family just because I’ve been reading your posts and following you, it’s literally a decade.

Tom: Yeah, well Howard thanks for creating Dentaltown because … for me if I didn’t have a place to go to get all these questions answered. Yeah.

Howard: We have to thank Al Gore for that. He’s the one who invented the internet while he was a congress man.

Tom: Yeah, first Al Gore then you.

Howard: All right buddy, well you have a rocking, hot day and I can’t wait to see you again. Are you going to the Townie meeting?

Tom: I haven’t gone yet but I’m going to commit to go. I haven’t done it so I’m going to take that step, it’s on the bucketlist. I have to do that.

Howard: Well you have to do it because you could actually bike route 66. That was Chicago, then Hollywood. That runs right by Las Vegas, so you could actually ride a bicycle from your office all the way to Vegas.

Tom: I’ll just hike a ride, I hate flying anyway so maybe I’ll just hop on the bike and go.

Howard: All right buddy, thanks so much for doing the interview with me.

Tom: Awesome. [Inaudible 01:00:25] internet.

Howard: Okay, bye-bye.

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